Comparision of the expandable nail with locked nail in the treatment of closed diaphyseal fractures of femur.

BACKGROUND: Expandable nails achieve stability only by hydraulic expansion; therefore suggest less radiation exposure and operation time. In this study, we aimed to compare the results of expandable femoral nails with locked intramedullary nails in the treatment of diaphyseal fractures of femur. MATERIALS AND METHODS: Isolated closed AO = Arbeitsgemeinschaft für Osteosynthesefragen type 32.A or 32.B unilateral femoral shaft fractures operated with expandable or locked nail were evaluated retrospectively. We match patients who undergone expandable nail fixation with patients of the same-sex, age, and fracture type who undergone locked nailing. A match was done for 31 expandable nail. At follow up, healing was assessed radiologically and clinically. Outcome measures included duration of hospital stay, time taken to achieve bony union, and participation in full activities. RESULTS: The average duration of surgery in the expandable group was 60.9 min and in the locked group was 82.4 min. In the expandable group, the average clinical healing time was 15.5 weeks and radiographic healing time was 21.7 weeks. In the locked IMN group, the average clinical healing time was 18.4 weeks and the average radiographic healing time was 24.1 weeks. We observed seven (22.6%) non-union in expandable group and four (12.9%) non-union in locked group. In the expandable group, type of the fracture was AO 32.B in all of the non-union patients. We achieved union in all of non-unions of the locked group only with dynamization. In the expandable IMN group, five (16.1%) patients required major surgery, in the locked group none of the patients required major surgery. CONCLUSION: Non-union rate of the expandable nail is higher than that of the locked nail for femoral diaphyseal fractures. It may be a treatment option in simple fractures like AO 32.A and in patients where rapid fixation is demanded. It has advantages of reduced operative time and less radiation exposure in comparison with reported series of conventional nails.

Effects of epidermal growth factor on reduction of the formation of thrombus and vessel wall healing in an experimental rat model.

OBJECTIVES: The aim of the current study was to investigate the synergistic effects of epidermal growth factor (EGF) and Enoxaparin in thrombus resolution. METHOD: Forty rats were divided into five groups (n = 8/group). Thrombosis was induced in all groups except the Sham group. Group 1: Sham; Group 2: Phosphate buffered saline; Group 3: Enoxaparin; Group 4: EGF; Group 5: EGF+Enoxaparin. The treatments were applied 2 hours preoperatively, then postoperatively at 48 hours. Rats were sacrificed 7 days after the 2nd injection. Tissue samples were examined with hematoxylin-eosin, trichrome, vascular endothelial growth factors (VEGF), von Villebrand factor (VWF), CD34 and CD68 for histopathological and immunohistochemical analyses. RESULTS: Neovascularisation, recanalization and macrophage accumulation were statistically significantly higher in the EGF+Enoxaparin group than the other groups (p < 0.05), and the volume of thrombus was determined to be significantly lower. Recanalization was found to be higher in the Enoxaparin group than in the other groups. As for the thrombus resolution, statistically significant regress in the EGF+Enoxaparin group (p < 0.05) compared to the other groups was found. Immunohistochemical antibodies were statistically higher in the EGF+Enoxaparin group than in the other groups (p < 0.05). CONCLUSION: The results of this study demonstrate that concomitant use of EGF and Enoxparin has a synergistic effect and contributes significantly to thrombus resolution (Fig. 10, Ref. 35).

Comparison of spin-echo T1- and T2-weighted and gradient-echo T1-weighted images at 3T in evaluating very preterm neonates at term-equivalent age.

Term-equivalent imaging can assess myelination status in very preterm infants (<30 weeks' gestational age at birth). However, myelination assessment has yet to be compared among GRE-T1WI, SE-T1WI, and SE-T2WI at 3T. We aimed to compare the rates of myelination among those 3 sequences in 11 very preterm neonates who underwent 3T MR imaging at term-equivalent age and subsequently had normal neurologic development. On each sequence, 2 neuroradiologists individually assessed 22 structures. SE-T2WI depicted a higher myelination rate (present in 58.2%-66.4% of all structures) than either GRE-T1WI (51.6%-63.9%) or SE-T1WI (20.5%-38.5%), while GRE-T1WI had the highest interobserver agreement (κ, 0.56; P < .0001). Myelination was present in 90%-100% of patients within the corpus callosum splenium, DSCP, ICP, lateral lemniscus, and spinal tract/nucleus of cranial nerve V on SE-T2WI, and in the DSCP, ICP, lateral lemniscus, medial lemniscus, pyramidal decussation, PLIC, and superior cerebellar peduncle on GRE-T1WI, occurring in similar structures as previously shown at 1.5T and 1T. However, it is not clear whether these findings represent true myelination versus precursors to myelination.

Detection of microhemorrhage in posterior reversible encephalopathy syndrome using susceptibility-weighted imaging.

BACKGROUND AND PURPOSE: PRES-related vasogenic edema is potentially reversible while hemorrhage occurs in only 15.2%-17.3% of patients. However, the true incidence of hemorrhage could be higher when SWI is considered. Thus, we set out to determine the incidence of MH, SAH, and IPH in PRES by using SWI and to particularly evaluate whether such MHs are reversible. MATERIALS AND METHODS: Thirty-one patients with PRES and SWI were included, 17 having follow-up SWI. Two neuroradiologists reviewed SWI, FLAIR, DWI, and CE-T1WI. The presence and number of MHs (<5 mm) on SWI, SAH, and IPH (>5 mm) were recorded at presentation and follow-up. We evaluated associations between the presence of MH on SWI and DWI lesions, SAH, IPH, contrast enhancement, and MR imaging severity. RESULTS: Hemorrhage was present in 20/31 patients (64.5%), with MHs on SWI in 18/31 (58.1%) at presentation and in 11/17 (64.7%) at follow-up. SAH was present in 3/31 on SWI and 4/31 on FLAIR, while 2/31 had IPH. At follow-up, no patients had acquired new MHs; 2/5 MHs in 1 patient resolved. Four patients with available SWI before PRES developed MHs after PRES onset. No association was found between the presence of MHs on SWI and DWI, SAH, IPH, enhancement, and MR imaging severity (all P > .05). CONCLUSIONS: SWI showed a higher rate of MH than previously described, underscoring the potential of SWI in evaluating PRES. Such MHs typically persist and may develop after PRES onset. However, the clinical relevance of MHs in PRES is yet to be determined. We propose that MHs in PRES relate to endothelial cell dysfunction.

Correlation between carotid bifurcation calcium burden on non-enhanced CT and percentage stenosis, as confirmed by digital subtraction angiography.

OBJECTIVES: Previous evidence supports a direct relationship between the calcium burden (volume) on post-contrast CT with the percent internal carotid artery (ICA) stenosis at the carotid bifurcation. We sought to further investigate this relationship by comparing non-enhanced CT (NECT) and digital subtraction angiography (DSA). METHODS: 50 patients (aged 41-82 years) were retrospectively identified who had undergone cervical NECT and DSA. A 64-multidetector array CT (MDCT) scanner was utilised and the images reviewed using preset window widths/levels (30/300) optimised to calcium, with the volumes measured via three-dimensional reconstructive software. Stenosis measurements were performed on DSA and luminal diameter stenoses >40% were considered "significant". Volume thresholds of 0.01, 0.03, 0.06, 0.09 and 0.12 cm(3) were utilised and Pearson'S correlation coefficient (r) was calculated to correlate the calcium volume with percent stenosis. RESULTS: Of 100 carotid bifurcations, 88 were available and of these 7 were significantly stenotic. The NECT calcium volume moderately correlated with percent stenosis on DSA r=0.53 (p<0.01). A moderate-strong correlation was found between the square root of calcium volume on NECT with percent stenosis on DSA (r=0.60, p<0.01). Via a receiver operating characteristic curve, 0.06 cm(3) was determined to be the best threshold (sensitivity 100%, specificity 90.1%, negative predictive value 100% and positive predictive value 46.7%) for detecting significant stenoses. CONCLUSION: This preliminary investigation confirms a correlation between carotid bifurcation calcium volume and percent ICA stenosis and is promising for the optimal threshold for stenosis detection. Future studies could utilise calcium volumes to create a "score" that could predict high grade stenosis.

Not the typical Tornwaldt's cyst this time? A nasopharyngeal cyst associated with canalis basilaris medianus.

We report a patient with a cystic structure in the nasopharynx mimicking a Tornwaldt's cyst, which was felt to represent a different entity owing to the lack of the distinct features of a typical Tornwaldt's cyst. It was associated with a bony cleft in the basiocciput that was considered to be a canalis basilaris medianus (CBM), thought to represent an embryological vestige of the cephalic end of the notochord along its course within the basiocciput.

MR imaging of Vogt-Koyanagi-Harada syndrome with leptomeningeal enhancement.

We describe a 28-year-old man with presumed VKH syndrome, whose presenting symptoms were bilateral impaired vision and headaches. Orbital MR imaging findings included bilateral choroidal and retrobulbar contrast enhancement, while brain findings included white matter abnormalities on FLAIR and leptomeningeal enhancement. Pachymeningeal enhancement has been described previously; herein, we report a patient with VKH syndrome presenting solely with leptomeningeal enhancement. Thus, MR imaging may detect early CNS involvement by VKH disease before the onset of neurologic symptoms.

Acute hepatic encephalopathy: diffusion-weighted and fluid-attenuated inversion recovery findings, and correlation with plasma ammonia level and clinical outcome.

BACKGROUND AND PURPOSE: In acute hepatic encephalopathy, MR imaging abnormalities have been described in the PVWM, thalami, and corticospinal tracts. We sought to determine characteristic regions of involvement on FLAIR and DWI, to evaluate their reversibility, and to correlate MR imaging extent with clinical severity. MATERIALS AND METHODS: Twenty patients who presented clinically with acute hepatic encephalopathy and MR imaging <21 days after symptom onset were reviewed retrospectively. Two neuroradiologists recorded involved regions on FLAIR and DWI in each, measured ADC values in affected regions and NAWM, and scored the MR imaging severity/extent. The initial severity (West Haven grade), follow-up clinical severity (degree of improvement), and maximal PAL within ±8 days of MR imaging were recorded and correlated with the MR imaging severity. RESULTS: On FLAIR and DWI respectively, there were abnormalities in the thalami (85%, 70%), PLIC (75%, 80%), PVWM (80%, 85%), and DBS (70%, 35%) and diffuse cortical involvement (30%, 25%). There were relatively strong significant (P < .005) correlations of FLAIR (r = 0.680, P = .001) and DWI severity (r = 0.690, P = .001) with PAL, and of PAL with the clinical outcome (r = 0.691, P = .001). Both FLAIR (r = 0.592, P = .006) and DWI (r = 0.487, P = .029) severity correlated moderately with the clinical outcome but were not significant at the P < .005 level after Bonferroni correction. CONCLUSIONS: Patients with acute hepatic encephalopathy may exhibit characteristic regions of involvement on FLAIR with DWI findings that can be reversible. The MR imaging extent on FLAIR and DWI strongly correlates with the maximal PAL, and PAL correlates well with the clinical outcome. Diffuse cortical involvement has a higher potential for neurologic sequelae but can be reversible.

Endovascular treatment of a ruptured aneurysm at a very rare location. Distal azygos anterior cerebral artery.

SUMMARY: We describe a patient with a small ruptured azygos anterior cerebral artery aneurysm located at a non-bifurcation distal site on the artery treated successfully with simple coiling.

Imaging Findings of a Patient with Incomplete Phenotypical Expression of the PHACES Syndrome.

SUMMARY: We present imaging findings of a patient with an incomplete form of the PHACES syndrome with dolichosegmental intracranial arteries as the predominant component, and discuss the etiopathological and clinical significance of this finding.

Spontaneous Bilateral Carotid Artery Dissection: Diagnosis and Follow-up with MDCT. A Case Report.

Carotid artery dissection is usually unilateral. Rarely bilateral forms can be seen. Recent studies have shown the efficacy of computed tomography angiography (CTA) in the diagnosis of carotid dissection. Herein we report a case with bilateral carotid artery dissection diagnosis and follow-up which was carried out using mainly CTA.

Dyke-Davidoff-Masson syndrome revisited: a didactic case with interesting imaging findings.

We present an adult female patient with Dyke-Davidoff-Masson syndrome with distinct features, and discuss neuroimaging findings some of which are unique to this syndrome.

Recurrent Cerebral Fat Embolism Due to Pleural Irrigation: Fat Density Lesions on CT. A Case Report.

Fat embolism syndrome is a rare, but life-threatening problem and is usually associated with severe trauma. Neurological symptoms are variable, and the clinical diagnosis is difficult. We describe a patient with fat density lesions on cranial CT sections and discuss the etiopathogenesis of cerebral fat embolism (CFE) in this patient who does not have a history of long bone fracture, but metastatic lung disease and empyema. This is probably the first case report of CFE secondary to pleural irrigation of empyema with demonstrative CT findings.

Diffusion-weighted cranial MR imaging findings in a patient with hemophagocytic syndrome.

Hemophagocytic lymphohistiocytosis (HLH) is a rare disorder of the immune system that is associated with frequent involvement of the central nervous system (CNS). The MR imaging and CT findings of the CNS infiltration have been reported in the past; however, the diffusion-weighted imaging (DWI) findings have not been previously described. We present MR imaging findings in a case of secondary HLH with CNS involvement, with an emphasis on the DWI findings.

Bilateral renal lymphangiomatosis mimicking hydronephrosis: multidetector CT urographic findings.

Renal lymphangiomatosis is a very rare disorder, with only a few reported cases. We present a case of bilateral renal lymphangiomatosis, manifested by bilateral flank pain, that was falsely diagnosed as hydronephrosis. Excretory urographic, ultrasonographic, and computed tomographic urographic findings are described.