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1.
BMC Infect Dis ; 24(1): 477, 2024 May 08.
Article in English | MEDLINE | ID: mdl-38720244

ABSTRACT

We report a very rare case of Listeria multiple brain abscesses manifested as delirium, which represented diagnostic and therapeutic challenges overcome only by the close cooperation between Infectious Diseases and Neuroradiology, without which a satisfactory outcome would not be achieved.An elderly man presented with confusion and drowsiness with a background of type-II diabetes mellitus. Although computed tomography of the brain only showed frontal lobe oedema, contrast magnetic resonance (MR) imaging showed numerous irregular rim-enhancing lesions containing central diffusion restriction, suggesting multiple pyogenic cerebral abscesses of unclear aetiology. Thereafter, Listeria monocytogenes was isolated from blood cultures, suggesting this as the causative organism. Deemed unsuitable for neurosurgical drainage, the patient received medical management with a protracted course of antibiotics. This case was extremely challenging, due to 1) the impossibility of source control, 2) the small number of effective antibiotics available to treat this condition, and 3) the inevitable antibiotic side-effects, derived from long-term exposure. A successful outcome was only possible thanks to strict close multidisciplinary follow up, requiring frequent MR imaging and a judicious antibiotic choice, including monitoring of their side-effects. Due to the rarity of this condition, there is lack of guidance on its management, hence the importance of multidisciplinary involvement with very close imaging and antibiotic monitoring.


Subject(s)
Anti-Bacterial Agents , Brain Abscess , Listeria monocytogenes , Listeriosis , Humans , Male , Brain Abscess/microbiology , Brain Abscess/drug therapy , Brain Abscess/diagnostic imaging , Listeriosis/drug therapy , Listeriosis/microbiology , Listeriosis/diagnosis , Anti-Bacterial Agents/therapeutic use , Listeria monocytogenes/isolation & purification , Aged , Magnetic Resonance Imaging , Tomography, X-Ray Computed , Brain/diagnostic imaging , Brain/pathology , Brain/microbiology , Delirium/drug therapy
2.
Radiology ; 307(5): e221362, 2023 06.
Article in English | MEDLINE | ID: mdl-37310248

ABSTRACT

Chimeric antigen receptor (CAR) T-cell therapy has revolutionized the treatment of large B-cell lymphoma (LBCL) and other hematologic malignancies. Its mechanism of action relies on recent biotechnological advances that allow clinicians to harness and enhance a patient's immune system to fight cancerous cells. The indications for CAR T-cell therapy continue to expand, with ongoing trials evaluating their use in other hematologic and solid organ malignancies. This review explores the vital role of diagnostic imaging in patient selection and treatment response in CAR T-cell therapy for LBCL and the management of specific therapy-related adverse events. For a patient-centered and cost-effective use of CAR T-cell therapy, it is crucial to select patients who are likely to derive long-term benefit and optimize their care during a lengthy treatment pathway. Metabolic tumor volume and kinetics assessed at PET/CT have emerged as powerful tools to predict outcome after CAR T-cell therapy in LBCL, allowing for the early identification of lesions refractory to treatment and identification of the severity of CAR T-cell therapy toxicity. Radiologists should be aware that the success of CAR T-cell therapy is mitigated by adverse events, most importantly neurotoxicity, which remains poorly understood and challenging to treat. Neuroimaging, with experienced clinical evaluation, is critical in the diagnosis and management of neurotoxicity and the exclusion of other central nervous system complications that can occur in this clinically vulnerable patient group. This review discusses current applications of imaging in the standard CAR T-cell therapy pathway for the treatment of LBCL, which serves as a model disease in the integration of diagnostic imaging and radiomic risk markers.


Subject(s)
Lymphoma, Large B-Cell, Diffuse , Neurotoxicity Syndromes , Receptors, Chimeric Antigen , Humans , Receptors, Chimeric Antigen/therapeutic use , Immunotherapy, Adoptive , Positron Emission Tomography Computed Tomography , Cell- and Tissue-Based Therapy
6.
J Neurovirol ; 27(4): 656-661, 2021 08.
Article in English | MEDLINE | ID: mdl-34101087

ABSTRACT

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) commonly results in a respiratory illness in symptomatic patients; however, those critically ill can develop a leukoencephalopathy. We describe two patients who had novel subacute MRI findings in the context of coronavirus disease 2019 (COVID-19) leukoencephalopathy, which we hypothesize could implicate a potent small-vessel vasculitis, ischemic demyelination and the presence of prolonged ischemia. Recent evidence of the direct neuroinvasiness of SARS-CoV-2 leading to ischemia and vascular damage supports this hypothesis.


Subject(s)
COVID-19/complications , Demyelinating Diseases/pathology , Leukoencephalopathies/pathology , Leukoencephalopathies/virology , Vasculitis, Central Nervous System/pathology , Demyelinating Diseases/virology , Female , Humans , Magnetic Resonance Imaging , Male , Middle Aged , SARS-CoV-2 , Vasculitis, Central Nervous System/virology
7.
Carbohydr Polym ; 230: 115620, 2020 Feb 15.
Article in English | MEDLINE | ID: mdl-31887961

ABSTRACT

The effect of replacing carbon black (CB) by rice husk derived type-I nanocellulose (RHNC) in natural rubber vulcanization is presented in this study. The synthesized RHNC was characterized using various analytical techniques like FTIR, XRD, SEM, TEM, DLS, TGA etc. The cure characteristics, mechanical, technological, thermal, barrier and dynamic mechanical properties of the composites were analysed. The mechanical properties of the NR composites containing 30 wt% of CB are comparable with the composite containing 25 wt% of CB and 5 wt% of RHNC. The DMA studies show that the loss tangent (tan δ) at 60 °C is lower for the composite containing 5 wt% of RHNC and 25 wt% CB compared to the composite containing 30 wt% CB. This shows that RHNC can impart low rolling resistance, which is a crucial parameter for green tire applications.

8.
Eur J Paediatr Neurol ; 17(5): 429-36, 2013 Sep.
Article in English | MEDLINE | ID: mdl-23685039

ABSTRACT

Isolated paediatric neurosarcoidosis (IPN) is exceptionally rare and only seven cases have been reported so far in the literature. We report the clinical and radiological profile of a 7 year-old boy with epilepsia partialis continua (EPC) who was initially thought to have Acute Disseminated Encephalomyelitis (ADEM), but was subsequently found to have isolated neurosarcoidosis. Additionally, we performed a literature search on Medline and Embase and secondary sources of data such as reference list of articles reviewed. Whilst cranial neuropathy is the commonest presenting feature in adults with neurosarcoidosis, paediatric patients are more likely to present with seizures. Diagnosis presents a clinical challenge as a result of its protean manifestations. Due to its rarity, there remains a lack of evidence base to inform the best choice of treatment for these children. Our patient was successfully treated with a combination of various immunomodulants.


Subject(s)
Central Nervous System Diseases/diagnosis , Central Nervous System Diseases/therapy , Encephalomyelitis, Acute Disseminated/diagnosis , Epilepsia Partialis Continua/diagnosis , Sarcoidosis/diagnosis , Sarcoidosis/therapy , Seizures/diagnosis , Central Nervous System Diseases/complications , Child , Diagnosis, Differential , Encephalomyelitis, Acute Disseminated/complications , Epilepsia Partialis Continua/physiopathology , Humans , Immunomodulation/immunology , Male , Sarcoidosis/complications , Seizures/complications , Treatment Outcome
9.
Br J Neurosurg ; 26(6): 919-20, 2012 Dec.
Article in English | MEDLINE | ID: mdl-22577848

ABSTRACT

We report a case of Terson's syndrome diagnosed by a CT head scan. The presence of vitreous haemorrhage may not be appreciated clinically in unwell patients with a subarachnoid haemorrhage. Therefore features of vitreous haemorrhage should be sought on CT head imaging in patients presenting with a subarachnoid haemorrhage.


Subject(s)
Subarachnoid Hemorrhage/therapy , Vitreous Hemorrhage/surgery , Embolization, Therapeutic , Humans , Male , Middle Aged , Syndrome , Tomography, X-Ray Computed , Vitrectomy
11.
J Vasc Interv Radiol ; 21(7): 1109-14, 2010 Jul.
Article in English | MEDLINE | ID: mdl-20478720

ABSTRACT

The authors describe their initial experience with the adjunctive use of Glubran 2, a cyanoacrylate glue, in the embolization of the internal iliac artery (IIA). Glubran 2 was used in five patients as an adjunct to traditional techniques in the repair of isolated IIA aneurysms and to prevent retrograde perfusion of the aneurysm sac in the endovascular repair of aortoiliac aneurysms.


Subject(s)
Aneurysm/therapy , Cyanoacrylates/administration & dosage , Embolization, Therapeutic/methods , Hemostatics/administration & dosage , Iliac Artery/drug effects , Tissue Adhesives/administration & dosage , Aged , Aged, 80 and over , Female , Humans , Male , Middle Aged , Retrospective Studies , Treatment Outcome
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