Diagnostic value of abdominal follow-up sonography in polytrauma patients: A retrospective study.

In many German trauma centres, it is routine to perform abdominal follow-up sonography (AFS) 6 h after admission for patients with multiple trauma, even if the clinical course is uneventful and multi-slice computed tomography (MSCT) reveals no abdominal pathology. However, this approach is not recommended in the German Guidelines for trauma, and recent studies have questioned the value of AFS to these patients. The present study aimed to evaluate the revised German Guidelines for trauma with respect to the omission of AFS.We included patients with multiple injuries with no clinical signs of abdominal trauma and with normal abdominal MSCT. We collected clinical data of 370 consecutive patients who underwent AFS (Group A) and another 370 consecutive patients who did not undergo AFS (Group B).No abdominal injury was missed by the omission of AFS, and thus, no patient suffered from its omission or benefitted from the use of AFS. In our study population, the negative predictive value of normal MSCT results combined with no clinical signs of abdominal trauma was 100% (95% confidence interval: 99.5%-100.0%).This single-centre study conducted in a large German trauma centre demonstrates AFS to have no utility in the diagnosis of abdominal injury. Moreover, omission of AFS for conscious patients without clinical signs of abdominal trauma and with negative abdominal MSCT does not appear to have negative consequences in terms of missed abdominal injury.Therefore, AFS can be safely omitted in the majority of cases of polytrauma, which simplifies the imaging workup tremendously.

Comparative analysis of CGUARD embolic prevention stent with Casper-RX and Wallstent for the treatment of carotid artery stenosis.

Stent protected Angioplasty of extracranial carotid artery stenosis using the dual-layered CGUARD stent is a novel treatment option. In this study we evaluate the feasibility and the safety of the CGUARD in symptomatic and asymptomatic patients in comparison to Casper-RX and Wallstent. This is a multi-center study of consecutive patients treated with the CGUARD, Casper-RX and Wallstent at two German high volume neurovascular centers between April 2017 and May 2018. Patient characteristics, neuroimaging data and angiographic outcome were retrospectively analyzed. The primary end points of the study were acute occlusion of the carotid stent and symptomatic intracerebral hemorrhage (sICH). Carotid artery stenting was performed in 76 patients; of those 26 (34%) were treated with the CGUARD, 25 (33%) with Casper-RX, and 25 (33%) with Wallstent. In 58/76 (76%) cases carotid artery stenosis was symptomatic with a median baseline National Institutes of Health Stroke Scale of 4. Angioplasty and stenting as part of a mechanical thrombectomy for acute ischemic stroke was performed in 25/76 (33%) patients. Baseline patient characteristics were similar between the treatment groups, except for a higher portion of scheduled cases in the Casper-RX group. There were no significant differences in the rate of acute in stent occlusions (CGUARD, 2/26 (8%); Casper-RX, 1/25(4%); Wallstent, 1/25 (4%)) and postinterventional sICH (1/26 (4%), 0/25(0%), 0/25 (0%)). Clinical outcome at discharge did not differ between groups. Treatment of carotid artery stenosis using CGUARD is feasible with a good safety profile comparable to that of Casper-RX and Wallstent.

Endoscopic laser-assisted diverticulotomy without versus with wound closure in the treatment of Zenker's diverticulum.

The aim of the present study was to compare the modifications of endoscopic laser-assisted diverticulotomy regarding closure of mucosal wound at the cricopharyngeal bridge. The results of 62 cases after endoscopic laser-assisted diverticulotomy without and with wound closure were retrospectively compared. After laser-assisted transection of the cricopharyngeal bridge, the mucosa wound was left open (OW) in 35 cases (56%), whereas a closure of the mucosa wound (CW) with sutures and fibrin glue was performed in 27 patients (44%). Duration of hospitalization, residual diverticular sac rate and occurrence of complications did not differ significantly between the two groups. Mean surgical time was significantly less in the OW cases. According to these results, it can be assumed that readapting and sealing the wound after transecting the cricopharyngeal bridge does not significantly reduce the complication rate. It does, however, extend the length of surgery and increases the cost of the procedure.

Intracranial ganglioglioma: clinicopathological and MRI findings in 16 patients.

AIM: To record the clinical findings and magnetic resonance imaging (MRI) characteristics of intracranial gangliogliomas in 16 patients. MATERIALS AND METHODS: Sixteen patients were imaged using unenhanced and contrast-enhanced MRI. Eight patients underwent unenhanced CT and of these, three underwent contrast-enhanced CT. Two radiologists read the images retrospectively. The images were studied with regard to location, size, margin, signal intensity, enhancement characteristics, cystic changes, and presence of calcifications. Clinical data, such as presenting signs and symptoms, physical findings, and medical histories, were collected. Histopathological and immunohistochemical studies were performed and analysed by two pathologists. RESULTS: In 12 cases the tumours were located in one of the cerebral hemispheres; in the other cases they were located in the brainstem, cerebellum, suprasellar area or the thalamus. The tumour dimension varied from 1-7 cm, with a mean of 3.6 cm+/-1.8 cm. The MRI features of ganglioglioma in the present cohort can be divided into three patterns: cystic (n=2), cystic-solid (n=6), and solid (n=8). Solid lesions had a predilection for the temporal lobe; cystic and cystic-solid tumours had a wide anatomical distribution. Cystic lesions were significantly smaller than both cystic-solid and solid lesions (F=4.28, P<0.05). Cystic changes in the cystic-solid tumours showed one of the following patterns: those with walls showing contrast enhancement, those containing an enhancing nodule, or cysts without an obvious wall. The solid portion of cystic-solid gangliogliomas and the entire tumour in solid tumours showed homogeneous enhancement of variable degrees on T1-weighted (T1W) spin-echo (SE) images. Five tumours had mild or moderate oedema. In one patient two separate gangliogliomas were found, each lesion exhibiting different MRI features: solid and cystic-solid. One case of cortical ganglioglioma was found, causing bone erosion due to pressure. One tumour with chronic haemorrhage was found in the study. CONCLUSION: MRI features of gangliogliomas are non-specific. A ganglioglioma should be suspected when a tumour shows the following features: (1) a solid lesion located in the temporal lobes with mild or no oedema and homogeneous enhancement on SE T1W images; or (2) a small cystic lesion or cystic-solid mixed mass with a wall enhancement or a markedly enhanced nodule. We report a patient with two separate gangliogliomas and a case with bone erosion.

Central neurocytoma: clinical, pathological and neuroradiological findings.

AIM: To evaluate the clinical, pathological and neuroradiological features of intraventricular central neurocytoma in six patients. MATERIALS AND METHODS: Six patients were imaged using non-enhanced and contrast-enhanced magnetic resonance imaging (MRI); three of them were also examined using non-enhanced computed tomography (CT). Two radiologists read the images retrospectively. The imaging data were studied with regard to location, size, margin, signal intensity, enhancement characteristics and presence of calcifications. Clinical data (i.e. presenting signs and symptoms, physical findings and medical histories) were collected and histopathological and immunohistochemical studies were performed by two pathologists. RESULTS: All lesions were located in the lateral ventricles. Three tumors were confined to the left side, one to the right side and two cases involved both lateral ventricles. The growth of central neurocytoma was of close spatial relation to the septum pellucidum. On MRI, most of the cases showed a heterogeneous hypointensity on T1-weighted images and hyperintensity on T2-weighted images or FLAIR with a well-defined margin. The presence of cystic components, necroses and calcifications caused these internal heterogeneities. After intravenous administration of gadolinium (Gd-DTPA) all tumours showed a heterogeneous enhancement. CT provided additional information by distinguishing intratumoural calcifications in all three evaluated cases. Immunohistochemical analysis showed positive synaptophysin staining in all cases and positive neuron-specific enolase staining in four cases. In three cases a small proportion of the tumour cells could be labelled with antibodies to glial fibrillary acid protein (GFAP). CONCLUSION: Central neurocytoma should be considered when the following conditions occur: young patients with lesions in the lateral ventricle, which contain calcifications and show some enhancement. This is especially applicable for tumours involving both lateral ventricles with symmetrical growth around the centre of septum pellucidum or for unilateral ventricular tumors with a wide base attachment to the septum pellucidum.

Cyclic shearing interferometer for collimating short coherence-length laser beams.

Until now there has not been an accurate method for measuring the radius of curvature, R, of a short coherence-length light source, such as a short-pulse or broadband laser. We show that the easily aligned cyclic shearing interferometer (CSI) solves this problem. The CSI produces a stable fringe pattern from which R can be determined and can be used on beams with short coherence times down to 300 fs because the two beams in the interferometer follow nearly the same path. Comparison with data from a broadband XeCl laser (30-ps coherence time) confirms that the CSI performs as theory predicts.