2-year survival estimation for decompensated cirrhosis patients of prognostic scoring systems.

OBJECTIVE: Prognostic models proposed for cirrhotic patients' survival have not been satisfactorily investigated in the Vietnam population, especially in the medium-term period. PATIENTS AND METHODS: In this prospective study, we enrolled a total of 904 patients admitted to Hepato-Gastroenterology Center, Bach Mai Hospital from December 2019 to November 2021 and calculated their CP, MELD, MELD-Na score, IMELD, Refit MELD, and Refit MELD-Na after 2-year follow-up to compare their survival prognosis. RESULTS: The mean age of the patients was 53.8 ±10.8 years, and males constituted 91%. Compared with the surviving group, deceased patients had statistically significant lower albumin, higher INR, serum bilirubin, and creatinine levels with higher means of all prognostic scores. RefitMELD score had the highest AUC (0.768), followed by MELD (0.766), and the lowest belonged to RefitMELDNa (0.669). CONCLUSIONS: In conclusion, deceased patients had significantly higher values of Child-Pugh score and all MELD-based scores than survival. RefitMELD is the most reliable scoring system to predict 2-year mortality in patients with decompensated liver cirrhosis.

Tuberculous otitis media in Vietnam: Clinical features and diagnostic difficulties.

OBJECTIVES: The purpose of this article is to draw the attention of otorhinolaryngologists to tuberculous otitis media in the light of two cases illustrating the diagnostic difficulties of this rare form of extrapulmonary tuberculosis, which often presents as subacute otomastoiditis or apparently benign chronic otitis media. It is characterized by symptoms such as atonic tympanic membrane perforation with granulation tissue, absence of any history of otitis media, facial paralysis or severe otosclerosis, and failure to respond to the usual treatments. CASE REPORTS: The first case was a 24-year-old man referred for right chronic otitis media present for 18 months despite topical treatment and tympanoplasty. The second case was a 21-year-old woman referred for right facial paralysis present for 8 days in a context of chronic otitis media, also treated medically for two years and by two tympanoplasties without success. CONCLUSION: The diagnosis of tuberculous otitis media is not based on histopathological examination, but bacteriological identification of Mycobacterium tuberculosis on an otorrhoea fluid sample collected according to the technique described here. A rigorous clinical approach should ensure early diagnosis and initiation of treatment to prevent complications and severe sequelae.

Description and phylogenetic analyses of ribosomal transcription units from species of Fasciolidae (Platyhelminthes: Digenea).

Many members of Fasciolidae are common trematodes in cattle, buffaloes, sheep, elephants, pigs, with some capable of infecting humans also. In this study, the complete or near-complete sequences of ribosomal transcription unit (rTU or rDNA), each of Fasciola hepatica (Australia), Fascioloides jacksoni (Sri Lanka), Fasciolopsis buski (Vietnam) and three isolates of F. gigantica (Vietnam), were obtained and characterized. The full length of rDNA for each F. hepatica, 'hybrid' Fasciola sp., Fas. jacksoni and Fa. Buski, was 7657 bp, 7966 bp, 7781 bp and 8361 bp, with the complete intergenic spacer region (IGS) (862 bp, 1170 bp, 987 bp and 561 bp), respectively. The rDNA of two 'pure' F. gigantica isolates from Vietnam was 6794 bp with unsequenced IGS. For 28S rRNA genes the Fasciola spp. are equal, 1958 bp for 18S, 160 bp for 5.8S, 3863 bp and 454 bp for ITS1 but ITS2 differ by one nucleotide (Thymine) (359 or 360 bp). The ITS1 of the sensu lato Fa. buski has some distinguishable features, 286 bp for ITS2, 3862 bp for 28S and four repeat units of 356-361 bp each found in ITS1. The 28S rDNA analysis showed the lowest level of divergence (0-0.57%) between F. hepatica and F. gigantica and higher (2.23-2.62%) and highest (6-6.42%) for Fas. jacksoni and Fasciolopsis, respectively. The tree of 43 strains/species clearly produced a well-supported phylogeny, where 18 fasciolids consistently grouped, forming a discrete Fasciolidae clade, distinct from Philophthalmidae, Echinostomatidae and Echinochasmidae in Echinostomatoidea. Fascioloides jacksoni is outside Fasciola spp.: basal with Fas. magna, as previously demonstrated.

Low-grade adenocarcinoma of probable endolymphatic sac origin: CT and MR appearance.

The CT and MR appearance of a case of low-grade adenocarcinoma of probable endolymphatic sac origin is presented. The tumor destroyed a large part of the posterior temporal bone and showed prominent extension into the posterior cranial fossa.

Assessment of carotid artery patency on routine spin-echo MR imaging of the brain.

We retrospectively reviewed the routine spin-echo MR studies of the brain in 12 patients with 13 angiographically demonstrated occlusions and in 14 patients with 16 high-grade stenoses of the carotid arteries. Intraluminal signal that was isointense with adjacent brain on long TR/short TE and long TR/long TE images was 100% specific for atherosclerotic occlusion. Of the 13 proved occlusions, six (46%) had significant degrees of hyperintense intraluminal signal indistinguishable from that observed consequent to slow flow distal to high-grade stenoses. MR detected only five (31%) of the 16 proved high-grade stenoses. Normal flow void does not exclude significant extracranial carotid stenosis. Occlusion cannot always be distinguished from high-grade stenosis when hyperintense intraluminal signal is encountered. However, a reliable diagnosis of atherosclerotic occlusion can be made when isointense intraluminal signal is observed.

Acute cervical spine trauma: correlation of MR imaging findings with degree of neurologic deficit.

A retrospective analysis of magnetic resonance (MR) imaging studies of 78 patients with acute cervical spinal cord injuries was undertaken to determine which observations related directly to the neurologic injury. All MR imaging studies were performed on a 1.5-T unit and assessed with respect to 14 parameters related to the bony spine, ligaments, prevertebral soft tissues, intervertebral disks, and spinal cord. Forty-eight patients also underwent non-contrast material-enhanced thin-section computed tomography (CT) of the cervical spine. MR imaging was the definitive modality in the assessment of soft-tissue injury, especially in the evaluation of the spinal cord and intervertebral disks. All patients with a neurologic deficit had abnormal spinal cords at MR imaging. Intramedullary hemorrhage was predictive of a complete lesion. The degree of associated bone and soft-tissue injury had no bearing on the extent of spinal cord injury or neurologic deficit. Patients with residual cord compression following reduction demonstrated greater neurologic compromise than those without compression.

Magnetic resonance imaging of acute cervical spine trauma. Correlation with severity of neurologic injury.

Prior to the advent of computer-assisted imaging techniques, conventional radiographic studies did not accurately depict the severity of soft tissue injury (spinal cord and paravertebral tissue) attending severe spinal trauma. Computed tomography scanning is clearly superior to plain radiography in the demonstration of osseous fractures and impactions, but this modality does not clearly depict ligamentous or disc injuries and does not image the spinal cord directly. The authors' preliminary experience indicates that magnetic resonance imaging (MRI) more accurately defines the extent of soft tissue damage in the zone of injury. In this study, the authors correlate these objective imaging techniques with findings on neurologic exam. Seventy-eight patients with cervical spine injuries admitted to the Regional Spinal Cord Injury Center of the Delaware Valley between August 1987 and January 1989 were evaluated with surface-coil MRI on a 1.5-Tesla unit. Fifty-nine patients were studied within 7 days of injury. Image sequences consisting of T1-, proton density, and T2-weighted images were obtained in saggital views. Axial gradient recalled acquisitions in the steady state (GRASS) images were obtained from most patients. We learned that certain patterns of MRI signal were associated with severe neurologic deficit. These include: 1) intramedullary hematoma and 2) spinal cord contusion associated with edema encompassing more than one spinal segment. Magnetic resonance imaging findings also correlated with less severe injury and include 1) normal spinal cord signal and 2) small focal contusions associated with edema encompassing one spinal segment or less.

Intracranial chondroma in a patient with Ollier's disease. Case report.

A case is presented in which a solitary chondroma arose from the clivus of a patient with Ollier's disease. These tumors are rare. The diagnostic value of computerized tomography and magnetic resonance imaging is discussed.

Exostosis of the internal auditory canal.

Although exostoses of the external auditory canal are not uncommon, those of the internal canal are extremely rare. One of these is described occurring in a 53-year-old man whose rapidly progressive hearing loss was without any associated abnormality.

Extracranial vascular angiography.

Noninvasive procedures (ultrasound, CT, and MRI) are increasingly valuable in the diagnosis of diseases of the head and neck. Angiography, however, is still essential in the demonstration of vascular pathology, including the preoperative evaluation of vascular neoplasms. Through angioplasty and embolization techniques, angiography also plays a leading role in the treatment of arteriosclerotic vascular disease, vascular malformations, and vascular neoplasms.

Aberrant internal carotid artery lying within the middle ear. High resolution CT diagnosis and differential diagnosis.

The CT signs of aberrant course of the internal carotid artery are presented and are contrasted against those of anomalously high jugular bulb, glomus tympanicum and cholesterol granuloma.