High comorbidity index is not associated with high morbidity and mortality when employing constrained arthroplasty as a primary treatment for intertrochanteric fractures in elderly patients.

AIM: The aim of our study is to investigate the results of constrained total hip arthroplasty as a primary treatment of intertrochanteric fractures (ITF) in elderly patients with high comorbidities. MATERIALS AND METHODS: Total hip replacement (THR) with a retentive cup was performed on 73 patients with ITF over the age of 54 years who had high comorbidities and a Charlson score above five. Short- and long-term complications were determined by follow-up. Bivariate analysis was conducted in order to determine the possible determinants of mortality and factors associated with comorbidity as measured by the Charlson comorbidities index. RESULTS: Patient demographics that consisted of females (58.9%) (p < 0.04) with the mean age of both males and females demonstrated no statistical significance. The mean hospitalization time and weight bearing time were 11 and 2.67 days, respectively. Only 4.1% needed re-intervention due to re-fracture and none due to prosthesis failure. There was a statistical significance between the comorbidity index and the mortality rate. However, no statistical significance was identified between the comorbidity index and the functional status after constrained THR. CONCLUSION: High comorbidity index is not associated with high morbidity and mortality when employing constrained arthroplasty as a primary treatment for ITF in elderly patients.

A systematic approach in the diagnosis of paediatric skull lesions: what radiologists need to know.

Paediatric skull lesions are commonly identified on imaging. They can be challenging to image, given their location and size, and often require several imaging modalities to narrow down the differential diagnosis. Accurate diagnosis of these lesions is paramount because the clinical therapy can vary tremendously. In this review, we provide a simple and systematic approach to clinical-radiological features of primary skull lesions. We highlight the imaging characteristics and differentiate pathologies based on imaging appearances. We also accentuate the role of cross-sectional imaging in lesion identification and management implications.

Severe arthritis and tenosynovitis caused by immune checkpoint blockade therapy with pembrolizumab (anti-PD-1 antibody).

Pembrolizumab, a monoclonal antibody against the immune checkpoint receptor-programmed cell death protein 1, has proven clinical efficacy in melanoma and other solid tumors. It increases the body's immune response against the tumor cells. However, because of an uninhibited immune system, immune-mediated adverse effects can arise. Though most adverse effects from pembrolizumab involve the gastrointestinal tract, skin, and endocrine system, rheumatologic manifestations are not very well defined. We describe two cases of severe inflammatory arthritis and tenosynovitis, which are rare adverse effects of pembrolizumab. Increased awareness of this manifestation is imperative to establish the diagnosis and initiate timely treatment.

PHACES syndrome with ectopia cordis and hemihypertrophy.

PHACES is the acronym describing the phenotypic association of posterior fossa anomalies, facial hemangioma, cardiac and eye anomalies, and sternal defects. To date, more than 300 cases of PHACE(S) have been reported. We present the case of a newborn girl who was born with a variant of the PHACES syndrome. Although the sternal cleft and the small facial hemangioma were evident clinically at birth, magnetic resonance imaging of the brain provided additional information to establish the diagnosis. In addition, the patient manifested later with hemihypertrophy, an association that has not been described previously.

Type 2 persistent primitive proatlantal intersegmental artery, a rare variant of persistent carotid-vertebrobasilar anastomoses.

We describe a 48-year-old man with type 2 persistent primitive proatlantal intersegmental artery found incidentally on imaging. It is one of the rare persistent carotid-vertebrobasilar anastomoses in which the anomalous vessel arises from the external carotid artery and enters the skull through the foramen magnum.

Reduced Contrast Volume and Radiation Dose During Computed Tomography of the Pancreas: Timing-Specific Contrast Media Protocol.

RATIONALE AND OBJECTIVE: To investigate the opacification of the pancreatic vasculature and parenchyma during computed tomography utilizing a patient-specific contrast formula. MATERIALS AND METHODS: This hybrid prospective and retrospective study was approved by the institution review board. In 220 consecutive patients, pancreatic CT was performed with one of two protocols: protocol A, 100mL of contrast material injected via timed bolus triggering technique; or protocol B, employing a patient-specific contrast media protocol specifically timed at the gastroduodenal artery; both protocols employed 4.5 mL/s contrast media and 100mL saline chaser. Attenuation of pancreatic parenchymal, arterial, and venous vasculature supplying the pancreas was measured. Effective dose was calculated. Data were compared to the independent two-sample t test. Receiver operating characteristic, visual grading characteristic, and Cohens' kappa analyses were performed. RESULTS: Mean pancreatic density measurements in each of the pancreatic segments during the arterial and venous phase were significantly higher in Protocol B (mean ± standard deviation, art: 96.59 HU ± 27.37; venous: 91.28 HU ± 20.88) compared to A (art: 77.86 HU ± 21.14; venous: 73.99 HU ± 14.75) (p < 0.0001). Mean arterial opacification was significantly higher in protocol B compared to A with the abdominal aorta (p < 0.007), superior mesenteric (p < 0.0002), gastroduodenal (proximal segment only p < 0.014), and splenic arteries (p < 0.036). In the venous circulation, the inferior vena cava, superior mesenteric, portal and splenic veins (all segments) demonstrated significant reduction in vascular opacification protocol B compared to A (p < 0.001). The contrast media volume in protocol B (57.60 ± 12.25 mL) was significantly lower than in protocol A (100 ± 1 mL) (p < 0.001). Effective dose was significantly reduced in protocol B (2.75 ± 0.63 mSv) compared to A (4.015 ± 0.89 mSv) (p < 0.001). Receiver operating characteristic and visual grading characteristic analysis demonstrated significantly higher area under the curve for protocol B (p < 0.0001) (p < 0.034) respectively, with inter-reader agreement increasing from good to excellent in pancreatic lesion detection. CONCLUSION: Timing-specific contrast media protocol enhances image quality at reduced contrast volume and radiation dose during computed tomography of the pancreas.