The feasibility of dual-energy CT to predict the probability of symptomatic intracerebral haemorrhage after successful mechanical thrombectomy.

AIM: To study the ability of dual-energy computed tomography (DECT) after successful mechanical thrombectomy (MT) to predict symptomatic intracerebral haemorrhage (sICH) in anterior circulation acute ischaemic stroke (AIS). MATERIALS AND METHODS: From June 2018 to February 2020, 102 AIS patients with DECT performed immediately after successful MT were enrolled prospectively. According to the presence of iodine contrast media extravasation (ICME) on DECT and subsequent sICH development, patients were classified into four groups. The neurological outcome was compared among groups. Imaging parameters, together with clinical factors, were investigated for sICH prediction based on a linear logistic regression model after class-imbalance resolved by Synthetic Minority Sampling Technique (SMOTE) method. RESULTS: Among 102 patients, patients (14.7%, 15/102) with the presence of sICH experienced worse outcomes than others without sICH (p<0.001). No case without ICME was observed with sICH development (0/102). The parameters derived from DECT have excellent performance for sICH prediction after successful MT, which is better than clinical predictive model boosted data (area under the curve [AUC]: DECT 0.87 versus clinical prediction 0.65), cross-validation results (AUC: DECT 0.87 versus clinical prediction 0.65), and original data (AUC: DECT 0.85 versus clinical prediction 0.68). By combining clinical and radiological parameters, the predictive performance for sICH could be further improved with an AUC of 0.90 (95% CI: 0.85-0.96). CONCLUSIONS: Based on DECT parameters acquired immediately after successful MT, the present model was more efficient than the clinical model for accurate prediction of sICH. Rho and ICME volume appeared to be the best parameters for predicting sICH using DECT.

[Surgery of fractures in the trochanteric region using Ender's method]. / Frakture v trohanterni regiji operirane po Enderu.

Our population is aging. The number of old persons is increasing and therefore we meet with fractures in the pertrochanteric region more frequently. We found that with proper indication osteosynthesis with Ender's nails has an advantage over other methods. The procedure is brief, it is not shock-producing and we can carry it out under spinal anaesthesia. By no other method known to us is it possible to mobilize the patient and to allow full weightbearing immediately after surgery. This results in the reduction of the high mortality which is a consequence of cardial and pulmonary complications. The urgent operation is carried out 8-10 hours after injury. Ender's elastic osteosynthesis was introduced in 1984 and so far 240 operations were performed. The average age of our patients was 75. Our oldest patient was 99, our youngest 37. We had 24 fatal outcomes, the majority during the period of introduction of the method. Observed retrospectively, in some cases death was the result of dubious indication.