Symptomatic Postoperative Compressive Pneumocephalus After Cholecystectomy.

A 75-year-old woman with a history of chronic hydrocephalus due to stenosis of the aqueduct of Sylvius was examined at the emergency department for altered mental status. There was placement of a ventriculoperitoneal shunt in 1970 complicated by meningitis, leading to removal of the material and ventriculociternostomy as definitive treatment in 2004. About one month previously, she had undergone a laparoscopic cholecystectomy complicated by an intra-abdominal collection. Clinical examination at the emergency department revealed a Glasgow score of 8 (E3 V1 M4). In the emergency department the patient presented a tonic-clonic seizure before a cerebral CT scan was performed showing a massive compressive pneumocephalus, then a second seizure. The patient was finally admitted to the neurosurgery department and underwent surgery. LEARNING POINTS: Changes in mental status in a patient with a history of chronic hydrocephalus should alert clinicians to a possible complication.This case reflects the delayed diagnosis of a critically ill patient in the emergency department.

Ecological Niche and Positive Clusters of Two West Nile Virus Vectors in Ontario, Canada.

West Nile virus (WNV) is a mosquito-borne pathogen associated with uncommon but severe neurological complications in humans, especially among the elderly and immune-compromised. In Northeastern North America, the Culex pipiens/restuans complex and Aedes vexans are the two principal vector mosquito species/species groups of WNV. Using a 10-year surveillance dataset of WNV vector captures at 118 sites across an area of 40,000 km2 in Eastern Ontario, Canada, the ecological niches of Cx. pipiens/restuans and Aedes vexans were modeled by random forest analysis. Spatiotemporal clusters of WNV-positive mosquito pools were identified using Kulldorf's spatial scan statistic. The study region encompasses land cover types and climate representative of highly populated Southeastern Canada. We found highest vector habitat suitability in the eastern half of the study area, where temperatures are generally warmer (variable importance > 0.40) and residential and agricultural cropland cover is more prominent (variable importance > 0.25). We found spatiotemporal clusters of high WNV infection rates around the city of Ottawa in both mosquito vector species. These results support the previous literature in the same region and elsewhere suggesting areas surrounding highly populated areas are also high-risk areas for vector-borne zoonoses such as the WNV.

Machine learning in orthodontics: Automated facial analysis of vertical dimension for increased precision and efficiency.

INTRODUCTION: The digitization of dentistry has brought many opportunities to the specialty of orthodontics. Advances in computing power and artificial intelligence are set to significantly impact the specialty. In this article, the accuracy of automated facial analysis for vertical dimensions using machine learning is evaluated. METHODS: Automated facial analysis of 45 patients (20 female, 25 male) was conducted. The subjects' ages were between 15 and 25 years (mean, 18.7; standard deviation, 3.2). A python program was written by the authors to detect the faces, annotate them and compute vertical dimensions. The accuracy of the manual annotation of digital images was compared with the proposed model. Intrarater and interrater reliability were evaluated for the manual method, whereas intraclass correlation and the Bland-Altman analysis were compared with manual and automated methods. RESULTS: The authors found acceptable intrarater reliability and moderate to poor interrater reliability for the manual method. The agreement was found between manual and automated methods of facial analysis. The 95% confidence interval limit of agreements was <10% for the metrics assessing vertical dimension. CONCLUSIONS: Machine learning offers the ability to conduct reliable and easily reproducible analyses on large datasets of images. This new tool presents opportunities for further advances in research and clinical orthodontics.

Osteogenesis imperfecta: potential therapeutic approaches.

Osteogenesis imperfecta (OI) is a genetic disorder that is usually caused by disturbed production of collagen type I. Depending on its severity in the patient, this disorder may create difficulties and challenges for the dental practitioner. The goal of this article is to provide guidelines based on scientific evidence found in the current literature for practitioners who are or will be involved in the care of these patients. A prudent approach is recommended, as individuals affected by OI present with specific dentoalveolar problems that may prove very difficult to address. Recommended treatments for damaged/decayed teeth in the primary dentition are full-coverage restorations, including stainless steel crowns or zirconia crowns. Full-coverage restorations are also recommended in the permanent dentition. Intracoronal restorations should be avoided, as they promote structural tooth loss. Simple extractions can also be performed, but not immediately before or after intravenous bisphosphonate infusions. Clear aligners are a promising option for orthodontic treatment. In severe OI types, such as III or IV, orthognathic surgery is discouraged, despite the significant skeletal dysplasia present. Given the great variations in the severity of OI and the limited quantity of information available, the best treatment option relies heavily on the practitioner's preliminary examination and judgment. A multidisciplinary team approach is encouraged and favored in more severe cases, in order to optimize diagnosis and treatment.

Initial FDG-PET/CT predicts survival in adults Ewing sarcoma family of tumors.

PURPOSE: The aim of this retrospective study was to determine, at baseline, the prognostic value of different FDG-PET/CT quantitative parameters in a homogenous Ewing Sarcoma Family of Tumors (ESFT) adult population, compared with clinically relevant prognostic factors. METHODS: Adult patients from 3 oncological centers, all with proved ESFT, were retrospectively included. Quantitative FDG-PET/CT parameters (SUV (maximum, peak and mean), metabolic tumor volume (MTV) and total lesion glycolysis (TLG) of the primary lesion of each patient were recorded before treatment, as well as usual clinical prognostic factors (stage of disease, location, tumor size, gender and age). Then, their relation with progression free survival (PFS) and overall survival (OS) was evaluated. RESULTS: 32 patients were included. Median age was 21 years (range, 15 to 61). Nineteen patients (59%) were initially metastatic. On multivariate analysis, high SUVmax remained independent predictor of worst OS (p=0.02) and PFS (p=0.019), metastatic disease of worst PFS (p=0.01) and high SUVpeak of worst OS (p=0.01). Optimal prognostic cut-off of SUVpeak was found at 12.5 in multivariate analyses for PFS and OS (p=0.0001). CONCLUSIONS: FDG-PET/CT, recommended at ESFT diagnosis for initial staging, can be a useful tool for predicting long-term adult patients outcome through semi-quantitative parameters.