Adding MR Diffusion Imaging and T2 Signal Intensity to Neck Imaging Reporting and Data System Categories 2 and 3 in Primary Sites of Postsurgical Oral Cavity Carcinoma Provides Incremental Diagnostic Value.

BACKGROUND AND PURPOSE: The NI-RADS lexicon doesn't use ADC parameters and T2 weighted signal for ascribing categories. We explored ADC, DWI, and T2WI to examine the diagnostic accuracy in primary sites of postsurgical oral cavity carcinoma in the Neck Imaging Reporting and Data System (NI-RADS) categories 2 and 3. MATERIALS AND METHODS: We performed a retrospective analysis in clinically asymptomatic post-surgically treated patients with oral cavity squamous cell carcinoma who underwent contrast-enhanced MRI between January 2013 and January 2016. Histopathology and follow-up imaging were used to ascertain the presence or absence of malignancy in subjects with "new enhancing lesions," which were interpreted according to the NI-RADS lexicon by experienced readers, including NI-RADS 2 and 3 lesions in the primary site. NI-RADS that included T2WI and DWI (referred to as NI-RADS A) and ADC (using the best cutoff from receiver operating characteristic curve analysis, NI-RADS B) was documented in an Excel sheet to up- or downgrade existing classic American College of Radiology NI-RADS and calculate diagnostic accuracy. RESULTS: Sixty-one malignant and 23 benign lesions included in the study were assigned American College of Radiology NI-RADS 2 (n = 33) and NI-RADS 3 (n = 51) categories. The recurrence rate was 90% (46/51) for NI-RADS three, 45% (15/33) for NI-RADS 2, and 73% (61/84) overall. T2WI signal morphology was intermediate in 45 subjects (53.5%) and restricted DWI in 54 (64.2%). Sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of the American College of Radiology NI-RADS were the following: NI-RADS (75.4%, 78.3%, 90.1%, 54.5%, and 76.1%); NI-RADS A (79.1%, 81.2%, 91.9%, 59.1%, and 79.6%); and NI-RADS B (88.9%, 72.7%, 91.4%, 66.7%, and 85.1%), respectively. CONCLUSIONS: Adding MR imaging diagnostic characteristics like T2WI, DWI, and ADC to the American College of Radiology NI-RADS improved diagnostic accuracy and sensitivity.

Do you observe what I perceive? The relationship between two perspectives on the ability of people with cognitive impairments to use everyday technology.

Objectives: Everyday technologies (ETs) can be challenging to use, particularly for older adults with cognitive impairments. This study evaluated the relationship between the self-perceived ability to use ET and observable performance of self-chosen and familiar, but challenging ETs in people with mild cognitive impairment (MCI) or dementia.Method: A self-perceived report, the Everyday Technology Use Questionnaire (S-ETUQ), and a structured observational tool, the Management of Everyday Technology Assessment (META), assessing the perceived and observed ability to use ET, were used in 41 people with MCI and 38 people with dementia. Correlations were investigated with non-parametric statistical tests.Results: In the dementia group, self-perceived report and observational scores correlated on a significant medium level (Rs=0.44, p = 0.006). In the MCI group, no significant correlation was found.Conclusion: The findings of this study suggest the ability of older adults with cognitive impairments to use ETs can be depicted with self-perceived reports as well as with observations. However, the combination of both approaches is recommended to get a comprehensive picture. While the S-ETUQ provides a broad picture of the use, presence and relevance of technologies in an individual's life, the META describes a specific human-technology interaction in detail. Furthermore, the results suggest people with early dementia retain the ability and insight to accurately reflect on their own ability to use ET, emphasizing the need to include their experiences in research and clinical work.

Panic symptoms in transient loss of consciousness: Frequency and diagnostic value in psychogenic nonepileptic seizures, epilepsy and syncope.

PURPOSE: Previous studies suggest that ictal panic symptoms are common in patients with psychogenic nonepileptic seizures (PNES). This study investigates the frequency of panic symptoms in PNES and if panic symptoms, just before or during episodes, can help distinguish PNES from the other common causes of transient loss of consciousness (TLOC), syncope and epilepsy. METHODS: Patients with secure diagnoses of PNES (n=98), epilepsy (n=95) and syncope (n=100) were identified using clinical databases from three United Kingdom hospitals. Patients self-reported the frequency with which they experienced seven symptoms of panic disorder in association with their episodes. A composite panic symptom score was calculated on the basis of the frequency of symptoms. RESULTS: 8.2% of patients with PNES reported "never" experiencing any of the seven panic symptoms in their episodes of TLOC. Patients with PNES reported more frequent panic symptoms in their attacks than those with epilepsy (p<0.001) or syncope (p<0.001), however, patients with PNES were more likely "rarely" or "never" to report five of the seven-ictal panic symptoms than "frequently" or "always" (45-69% versus 13-29%). A receiver operating characteristic analysis demonstrated that the composite panic symptom score distinguished patients with PNES from the other groups (sensitivity 71.1%, specificity 71.2%), but not epilepsy from syncope. CONCLUSIONS: Patients with PNES report TLOC associated panic symptoms more commonly than those with epilepsy or syncope. Although panic symptoms are reported infrequently by most patients with PNES, a composite symptom score may contribute to the differentiation between PNES and the other two common causes of TLOC.

Infected hydrocele following laparoscopic appendectomy: case report.

In the literature, specific reported complications after laparoscopic appendectomy include bowel injury, hemorrhage, wound infection, and cecal fistula. We report the occurrence of infected hydrocele after laparoscopic appendectomy in a 20-year-old man. This complication, to our knowledge, has not yet been described in the literature.

Should chemical sympathectomy precede below knee amputation?

Lumbar sympathectomy has a controversial place in the management of severe limb ischemia for limb preservation. In a consecutive clinical series laser Doppler (LD) blood flow was measured at the distal limit of an anterior below knee skin flap in 21 patients. Amputation level was selected by clinical judgement. Mean LD value in 15 patients who had primary BK healing was 42V (range 20-85) compared to 11V (9-20) in six patients who proceeded to AK amputation (p < 0.001) establishing 20V as a critical value for BK healing. To examine the effect of chemical sympathectomy 21 further patients with severe ischemia had LD measurements at the same BK site before and one week after chemical sympathectomy. LD values rose significantly from 26V (10-75) to 50V (10-100), (p < 0.001). In particular seven patients had initial LD levels below 20V and in five chemical sympathectomy produced elevation to levels commensurate with BK healing. We conclude that chemical sympathectomy can improve below knee skin blood flow and may enhance primary wound healing.

Sternal fractures: a red flag or a red herring?

We reviewed the records of 28 patients with sternal fractures. Seat belts were used by 79% of the patients. Pain and tenderness were the most common complaints. Forty-six percent of patients had associated injuries, which were all evident in the emergency room. Seven patients had rib fractures, six had myocardial contusion, and five had pulmonary contusions. The associated injuries determined the outcome: 2 patients died, 2 required rehabilitation, the rest recovered uneventfully. Mean length of stay (LOS) was 8.17 +/- 1.78 days, but the median LOS was 4 days, and 75% stayed a week or less. The sternal fracture was treated with rest and analgesics. We conclude that sternal fractures are benign and do not require special treatment or an expensive work-up. It is possible that the seat belt and the sternal fracture absorb a substantial part of the energy transfer, and prevent greater damage.

Spontaneous disappearance of limy bile. A cause of acute pancreatitis?

The spontaneous disappearance of limy bile from the gallbladder causing transient obstructive jaundice and acute pancreatitis is extremely rare. Only five cases causing obstructive jaundice alone have so far been reported. We report a patient with obstructive jaundice and acute pancreatitis in whom the initial abdominal film showed limy bile in the gallbladder, which subsequently disappeared in the following abdominal films.

Adrenal cysts: diagnosis and therapeutic approach.

We report nine cases of adrenal cysts, treated in our hospital, between 1980 and 1990. The majority of the cases (5/9) were incidental findings on US and CT examinations. We operated on 4/9 cases because of their symptomatology or their size. Four other cases were managed conservatively; one last case was treated by percutaneous drainage under CT. In our series, 1/9 (11%) was a malignant cyst. The follow-up shows excellent results in the benign cases and 40 months' survival in the malignant case, until today.

[Volvulus of the transverse colon. Apropos of three cases]. / Volvulus du côlon transverse. A propos de trois cas.

Volvulus of the transverse colon is a very rare entity, representing 1 to 3.4% of all volvuli of the colon. We report three cases illustrating the problems of this pathology. The presentation is usually acute, leading to prompt surgery. Multiple etiologies may be combined: congenital malrotations of the gut, chronic constipation in the elderly enhanced by psychiatric medications, and mechanical by adhesion bands which help to create anomalous rotation axes for the volvulus. The best treatment must be surgical, and we recommend an aggressive approach: an extended right colectomy, which gave good results in our patients.

Management of periareolar abscess and mamillary fistula.

During a 15 year period, 18 patients with 28 mamillary fistulas were treated. In eight women, periareolar abscess had preceded recognition of a fistula. Ten patients were primarily diagnosed as having mamillary fistula. In six patients, when the underlying fistula tract was not identified and excised at the time of operation, discharging sinus reoccurred. Twenty-two fistulas were completely excised together with an extensive lactiferous duct system. Operative wound was primarily closed using antibiotic cover. Periareolar abscess and mamillary fistula should be treated primarily by complete excision of the fistula tract and extensive duct system of the breast.

Isolated popliteal artery occlusion in the young.

Three young patients with an isolated popliteal artery occlusion are presented, two with severe claudication and the third with a critical ischaemic foot. The work-up of these patients leads to certain aetiologic possibilities: microtrauma, smoking and contraceptive pills. Two of our patients underwent thromboembolectomy, the third managed conservatively. The follow-up was between six months and seven years and up to now all three patients remain well.

PIP: 3 cases of popliteal artery occlusion are described, in 2 young Israeli women and a young man, and the etiologic factors in this rare disorder are reviewed. The 1st case was a 20-year old healthy woman with no contributing factors except use of low dose oral contraceptives for 5 months. She had suffered for 3 months with claudication of her left leg. Her Doppler ankle-brachial index was 0.7, and her angiogram showed complete occlusion of the popliteal artery and partial occlusion of the tibio-peroneal. She was treated with aspirin and cardoxine, discontinuation of oral contraceptives and walking, and recovered. The 2nd case was a 33-year old woman with history of rheumatic fever, obesity, hirsutism, venous thrombosis, hormone therapy for infertility, multiple spontaneous abortions, smoking, and possible Cushings disease. Her findings included and AB index of 0.45 on the right, and spotty stenosis of the popliteal artery. She was treated surgically with a Fogarty catheter, and is well 3 years later with the help of anticoagulants. The 3rd patient was a 30-year old male athlete who smoked heavily. He had an AB index of 0.4 on the left and complete blockage of the popliteal artery, so he received longitudinal arteriotomy and thrombectomy. He was put on anticoagulants, and is well, 6 months after surgery. Oral contraceptives were considered the likely cause of the 1st young woman's claudication, and possibly involved in the 2nd patient's ischemia. It is usually difficult to define the cause of isolated popliteal artery occlusion in young adults. Multidisciplinary management with thrombolytics or surgery should be considered, and discontinuation of oral contraceptives should be a priority, especially if a young woman began using them in the last year.

[Abscess of the abdominal wall: a rare presentation of xanthogranulomatous pyelonephritis]. / Abcès de la paroi abdominale: une présentation rare d'une pyélonéphrite xanthogranulomateuse.

A young psychiatric patient presented with a purulent collection in the lower abdominal wall. Simple drainage failed to heal the abdominal wall abscess, and the presence of a primary septic focus was suspected. Full investigation showed a right renal pelvis calculus with xanthogranulomatous pyelonephritis complicated by a retroperitoneal abscess. Recovery was complete after a nephrectomy. A review of the published literature demonstrated the rarity of this presentation, although even more curious cases have been described, including a urinobronchial fistula, as well as catastrophic cases presenting with a massive haemorrhage. Authors are unanimous that ultrasonography should be the first examination, the scanner being also of primordial value for the diagnosis and demonstration of the retroperitoneal spaces ans fascia. Treatment requires both rapid and radical surgical intervention.

[Is enterolithiasis a disease occurring more frequently in desert climate? Apropos of 8 cases]. / Entérolithiase, une pathologie plus fréquente en région désertique? A propos de huit cas.

This work is a report about 8 cases of enterolithiasis treated in our University Hospital between 1980 and 1990. We emphasize the rarity of this condition. We also note its relative frequency (5 of 8 cases) in the Bedouin population of our mostly desertic area, and question the possible impact of a diet rich in goat's milk and/or of tuberculosis, which is still endemic in some tribes. We then discuss the difficulties of diagnosis and the essential contribution of small bowel radiographs. The etiologies of enterolithiasis are reviewed, as well as the various modalities of treatment.

[Cystadenocarcinoma with peritoneal involvement (pseudomyxoma peritonei). Is surgical resection alone sufficient?]. / Cystadénocarcinome avec atteinte péritonéale (pseudomyxome péritonéal). L'exérèse chirurgicale seule est-elle suffisante?

We present our experience of 10 cases of pseudomyxoma peritonei treated in our regional hospital between 1978 and 1992. We note the rarity of this disease; the catastrophic macroscopic appearance may mislead the in experienced surgeon. Preoperative diagnosis is usually easy when confronted with a mass in an ascitic abdomen, with the help of ultrasonography and CT-scan, and above all after abdominal puncture which produces pathognomonic gelatinous fluid. Most cases are derived from the ovary and appendix. Treatment is surgical and aggressive; we adopt the protocol proposed by Sugarbaker which combines repeated surgery and local and systemic chemotherapy. The relatively good survival, even in the malignant cases, seems to be improved by this treatment.