Predicting Acute Cardiovascular Complications in COVID-19: Insights from a Specialized Cardiac Referral Department.

BACKGROUND COVID-19 increases the risk of acute cardiovascular diseases (CVDs), including acute coronary syndrome (ACS), acute pulmonary embolism (APE), and acute myocarditis (AMyo). The actual impact of CVDs on mortality of patients with COVID-19 remains unknown. This study aimed to determine whether CVDs influence the course of COVID-19 pneumonia and if they can be easily detected by using common tests and examinations. MATERIAL AND METHODS Data of 249 consecutive patients with COVID-19 hospitalized in a dedicated cardiology department were analyzed. On admission, clinical status, biomarkers, computed tomography, and bedside echocardiography were performed. RESULTS D-dimer level predicted APE (AUC=0.850 95% CI [0.765; 0.935], P<0.001) with sensitivity of 69.4% and specificity of 96.2% for a level of 4968.0 ng/mL, and NT-proBNP predicted AMyo (AUC=0.692 95% CI [0.502; 0.883], P=0.004) and showed sensitivity of 54.5%, with specificity of 86.5% for the cut-off point of 8970 pg/mL. Troponin T levels were not useful for diagnostic differentiation between CVDs. An extent of lung involvement predicted mortality (OR=1.03 95% CI [1.01;1.04] for 1% increase, P<0.001). After adjusting for lung involvement, ACS increased mortality, compared with COVID-19 pneumonia only (OR=5.27 95% CI [1.76; 16.38] P=0.003), while APE and AMyo did not affect risk for death. CONCLUSIONS D-dimer and NT-proBNP, but not troponin T, are useful in differentiating CVDs in patients with COVID-19. ACS with COVID-19 increased in-hospital mortality independently from extent of lung involvement, while coexisting APE or AMyo did not.

Posterior Dislocation of the Long Head of Biceps Tendon after Traumatic Anterior Shoulder Dislocation.

Teaching point: An irreducible anterior glenohumeral joint dislocation associated with a displaced fracture of greater tuberosity, a rotator cuff tear, or a coracoid process fracture should raise the suspicion of posterior long head of biceps tendon (LHBT) dislocation.

Spinal Involvement in Patients with Chronic Non-Bacterial Osteomyelitis (CNO): An Analysis of Distinctive Imaging Features.

Spinal involvement by chronic non-bacterial osteomyelitis (CNO) has been increasingly reported in recent years, often being presented as a diagnostic dilemma requiring differential diagnosis with bacterial spondylodiscitis and/or neoplasia. This study was aimed at identifying the imaging features of CNO facilitating its differentiation from other spinal diseases. Two radiologists assessed the imaging studies of 45 patients (16 male and 29 female, aged from 6 to 75 years, 15 children) with CNO collected from 5 referential centers. Spinal lesions were found in 17 patients (2 children and 15 adults), most often in the thoracic spine. In children, the lesions involved short segments with a destruction of vertebral bodies. In adults, the main findings were prominent bone marrow edema and osteosclerosis, endplate irregularities, and ankylosing lesions extending over long segments; paraspinal inflammation was mild and abscesses were not observed. In both children and adults, the involvement of posterior elements (costovertebral and facet joints) emerged as an important discriminator between CNO and neoplasia/other inflammatory conditions. In conclusion, a careful inspection of imaging studies may help to reduce the number of biopsies performed in the diagnostic process of CNO.

Trap Parameters for the Fast OSL Signal Component Obtained through Analytical Separation for Various Quartz Samples.

Trap stability is essential in luminescence dating and thermochronometry. Trap depth and frequency factors determining the stability of the fast component of optically stimulated luminescence (OSL) in quartz, which is the most important in dating, have yet to be uniquely determined, especially for samples with an OSL signal not dominated by this component. One can determine them in OSL thermal depletion curve (OTDC) experiments. The separation of the fast OSL signal undisturbed by other OSL components is vital for obtaining accurate parameters for the traps of interest. This work presents a method of simultaneous thermal and optical stimulation using red light (620 nm) to separate the fast OSL component (the thermally modulated OSL method-TM-OSL). The OTDC experiment with the TM-OSL stimulation was used for the trap parameter determination on a variety of quartz samples, leading us to report for the first time, the trap parameters for the fast OSL component analytically separated in quartz from rock samples. The results obtained for these samples with the fast component of low intensity are consistent with those with an intensive fast OSL component. Results of OTDC measurements for all investigated quartz samples were tested for a wide range of irradiation doses.

Radiographic Measurement of Gastric Remnant Volume After Laparoscopic Sleeve Gastrectomy: Assessment of Reproducibility and Correlation with Weight Loss.

BACKGROUND: As a restrictive procedure, laparoscopic sleeve gastrectomy (LSG) relies primarily on the reduction of gastric volume. It has been suggested that an immediate postoperative gastric remnant volume (GRV) may influence long-term results of LSG; however, there are no consensus in this matter. The aim of this study was to assess the reproducibility of different radiographic methods of GRV calculation and evaluate their correlation with the weight loss (WL) after surgery. METHODS: This retrospective study evaluated 174 patients who underwent LSG in the period from 2014 to 2017. Using UGI, GRV was measured with 3 different mathematical methods by 2 radiologists. Intraobserver and interobserver calculations were made. Correlation between GRV and WL were estimated with calculations percentage of total weight loss (%TWL) and percentage of excess weight loss (%EWL) after 1, 3, 6, 12, 18, and 24 months postoperatively. RESULTS: During analysis of intraobserver similarities, the results of ICC calculation showed that reproducibility was good to excellent for all GRV calculation methods. The intraobserver reproducibility for Reader I was highest for cylinder and truncated cone formula and for Reader II for ellipsoid formula. The interobserver reproducibility was highest for ellipsoid formula. Regarding correlation between GRV and WL, significant negative correlation has been shown on the 12th month after LSG in %TWL and %EWL for every method of GRV calculation, most important for ellipsoid formula (%TWL - r(X,Y) = -0.335, p < 0.001 and %EWL - r(X,Y) = -0.373, p < 0.001). CONCLUSION: Radiographic methods of GRV calculation are characterized by good reproducibility and correlate with the postoperative WL.

Intracranial Transthecal Fat Migration After a Sacral Fracture: 2 Case Reports.

BACKGROUND The presence of fat droplets within the subarachnoid space is an uncommon finding, which is almost exclusively associated with a ruptured dermoid cyst. In a trauma setting, transthecal migration of fat droplets is an extremely rare occurrence. We present 2 case reports of intracranial transthecal migration of fatty bone marrow after sacral fractures. CASE REPORT Both patients presented to the Emergency Department (ED) after falls from a standing height. The first patient, an 84-year-old woman, suffered a stable sacral fracture extending into a large meningeal cyst within the right S2 foramen. Her initial neurological assessment and computed tomography (CT) of the head were unremarkable. As the fracture did not require surgical treatment, she was discharged home and prescribed bed rest, analgesics, and venous thromboembolism prophylaxis. Three days after the injury, she was readmitted to the ED with a mild headache, dizziness, and an episode of nausea and vomiting. A follow-up head CT revealed fat droplets in the subarachnoid space and lateral ventricles. After successful symptomatic treatment, she was discharged home in good general condition. The second patient, a 60-year-old man, underwent a head CT for a scalp hematoma, which revealed fat droplets in the 3rd ventricle and right lateral ventricle. The pelvic CT revealed a large sacral meningeal cyst with microfractures in its wall. He was discharged home on the same day and prescribed bed rest and analgesics. CONCLUSIONS The detection of intracranial intrathecal fat droplets in association with a specific trauma mechanism should initiate the search for a sacral fracture.

Gorham-Stout disease involving ipsilateral clavicle and scapula in a child - a case report focusing on imaging and histopathological features of this extremely rare condition.

Gorham-Stout disease (GSD) is a very rare entity of unknown etiology, characterized by excessive intra-osseous proliferation of blood or lymphatic vessels, resulting in progressive resorption of bone matrix and destruction of bone. To date we have found only seven published cases concerning fully confirmed GSD of the shoulder girdle bones in children. Our case concerns an 8-year-old boy with involvement of the left clavicle and scapula. The knowledge of imaging and histopathological features is crucial for establishing the diagnosis of GSD, therefore the exchange of experiences in this field is essential for improving the care of affected patients.

Imaging after laparoscopic sleeve gastrectomy - literature review with practical recommendations.

In the XXI century obesity has become one of the most demanding epidemiological threats worldwide. At the same time, bariatric surgery has established itself as an effective treatment for morbidly obese patients, with laparoscopic sleeve gastrectomy (LSG) emerging as the most popular bariatric procedure. This paper reviews the role of imaging studies of patients after LSG. Computed tomography is widely considered as the method of choice in detection of complications in early postoperative period. The dynamic character of upper gastrointestinal examination allows for the assessment of passage through the gastric remnant. The paper also discusses evaluation of the shape and volume of the gastric remnant assessed by imaging studies.

The Use of Scoring Hip Osteoarthritis with MRI as an Assessment Tool for Physiotherapeutic Treatment in Patients with Osteoarthritis of the Hip.

Rehabilitation programs are considered effective at reducing the impact of osteoarthritis (OA) of the hip; however, studies using reliable measures related to OA biomarkers to assess the effects of rehabilitation are lacking. The objective of this study was to investigate whether an MRI-based (Magnetic Resonance Imaging-based), semi-quantitative system for an OA severity assessment is feasible for the evaluation of the structural changes in the joint observed during a long-term physiotherapy program in patients with hip OA. The study group consisted of 37 adult OA patients who participated in a 12-month physiotherapy program. The Scoring hip osteoarthritis with MRI (SHOMRI) system was used to evaluate the severity of structural changes related to hip OA. Hip disability and the osteoarthritis outcome score (HOOS) and the core set of performance-based tests recommended by Osteoarthritis Research Society International were used for functional assessment. SHOMRI showed excellent inter- and intra-rater agreement, proving to be a reliable method for the evaluation of hip abnormalities. At the 12-month follow-up no statistically significant changes were observed within the hip joint; however, a trend of structural progression was detected. There was a negative correlation between most of the SHOMRI and HOOS subscales at baseline and the 12-month follow-up. Although SHOMRI provides a reliable assessment of the hip joint in patients with OA it showed a limited value in detecting significant changes over time in the patients receiving physiotherapy over a 12-month period.

Plasma growth differentiation factor 15 levels for predicting serious adverse events and bleeding in acute pulmonary embolism: a prospective observational study.

INTRODUCTION: Growth differentiation factor 15 (GDF­15), a cytokine induced in the myocardium by pressure overload and ischemia, has a well­established prognostic role for diseases of the left ventricle. Plasma GDF­15 concentrations were shown to predict bleeding events in patients with atrial fibrillation on anticoagulation. OBJECTIVES: To investigate the prognostic value of GDF­15 in acute pulmonary embolism (PE). PATIENTS AND METHODS: This was a prospective observational study of 77 patients hospitalized for PE. The median length of hospital stay and follow-up was 9 days. Plasma GDF­15 levels were measured using an automated sandwich electrochemiluminescence immunoassay. The outcome measures were: 1) in­hospital serious adverse events (SAE; death, cardiopulmonary resuscitation, need for urgent reperfusion therapy, catecholamine administration), and 2) major bleeding or nonmajor clinically relevant bleeding. RESULTS: There were 12 SAE and 5 bleeding events. The median (interquartile range) GDF­15 concentration at admission was 2354 ng/l (1151-4750 ng/l). GDF­15 concentrations increased according to risk subgroup. Patients with serious adverse events or bleeding events had higher baseline concentrations of GDF­15 (median [interquartile range], 3460 ng/l [2 531-12 363 ng/l] vs 2034 ng/l [1121-4449 ng/l]; P = 0.01). The area under the curve for GDF­15, high­sensitivity cardiac troponin T, and N­terminal pro-brain natriuretic peptide concentrations for predicting SAE was similar, the area under the curve of GDF­15 levels for predicting bleeding was 0.783 (95% CI, 0.62-0.946; P = 0.001) and 0.71 (95% CI, 0.567-0.853; P = 0.004) for predicting any adverse event. In the multivariable analysis, GDF­15 greater than 1680 ng/l emerged as an independent predictor of adverse outcomes (odds ratio, 8.9; P = 0.047). CONCLUSIONS: Plasma GDF­15 concentrations may be a promising biomarker for predicting hemodynamic destabilization and bleeding complications in PE.

Spinal Cord Ischemia Because of Microvascular Thrombosis in a Patient with Necrotizing Pancreatitis. Case Report and Literature Review.

BACKGROUND Central nervous system ischemia in acute pancreatitis is rare with only a handful of cases reported in the literature. We report a case of spinal cord ischemia due to microvascular thrombosis complicating acute on chronic pancreatitis. CASE REPORT A 37-year-old male was transferred to a university hospital intensive care unit with a diagnosis of acute onset chronic pancreatitis, paraplegia, and multi-organ failure. Laboratory studies showed elevated serum amylase activity and leukocytosis. The patient deteriorated quickly and anemia with thrombocytopenia and coagulation abnormalities developed. Computed tomography showed large pancreatic pseudocyst and ischemic lesions in abdominal organs. Symptoms of paraplegia preceded by the bilateral paresis were noted 7 days from the onset of his disease and magnetic resonance imaging showed ischemia involving the central part of the medullary cone resulting from microvascular thrombosis. The patient underwent endoscopic retrograde cholangiopancreatography and repeated surgery with a number of complications but 2 months later was discharged to rehabilitation center due to persistent neurologic deficit. CONCLUSIONS Patients with severe pancreatitis and multiorgan failure requiring intensive care should undergo routine neurological examination to identify and treat deficits early.

Diffusion Weighted Magnetic Resonance Imaging in the Assessment of Renal Function and Parenchymal Changes in Chronic Kidney Disease: A Preliminary Study.

BACKGROUND The aim of this study was to evaluate the feasibility of using intravoxel incoherent motion (IVIM) imaging for noninvasive assessment of pathologic changes in chronic kidney disease (CKD). MATERIAL AND METHODS Thirty-four patients with CKD and 20 healthy volunteers were examined on a 1.5 T magnetic resonance imaging (MRI) unit. The examination consisted of morphologic sequences and diffusion-weighted echo-planar sequence with 10 b values. Diffusion parameters were calculated with the use of mono- (apparent diffusion coefficient, ADC) and bi-exponential model: pure diffusion coefficient (D) and perfusion fraction (Fp). Blood samples to assess the serum creatinine level were taken immediately before examination. Ultrasound guided biopsies were performed in less than 30 days from MRI and were scored by an experienced nephropathologist. Parametrical unpaired t-test and ROC curve analysis were used to investigate differences in diffusion parameters in relation to estimated glomerular filtration rate (eGFR). Pearson's correlation coefficients were calculated to assess relationship between diffusion parameters and laboratory and histopathological markers of renal damage. P-value <0.05 indicated statistical significance. RESULTS Both ADC and D correlated positively with eGFR (respective r 0.74 and 0.72), however D showed a more significant correlation with histopathology: while D correlated negatively with parameters reflecting chronic glomerular (r -0.48) and tubulo-interstitial changes (r -0.47), ADC correlated only with interstitial infiltrations (r -0.44). Flow-related diffusion parameters showed high standard deviation. CONCLUSIONS IVIM imaging is sensitive to functional and morphologic changes in CKD. The separation of influence of Fp from true diffusion improves the assessment of chronic changes in renal parenchyma.

OSL CHARACTERISTICS: THEORY AND EXPERIMENTS.

Fundamental effects such as the participation of crystal lattice vibrations should be taken into account while considering photo-ionisation in solids at measurement temperatures characteristic for dosimetric applications. The impact of these effects on the optically stimulated luminescence (OSL) can be recognised for example by changes in the optical cross-section of the trap with the stimulation energy and the temperature. The OSL signal observed during the stimulation with variable energy, during the linear heating of a sample or during the stimulation with modulation of the shape of a spectral band can provide important information about the properties of the trap. Moreover, such methods when applied with carefully selected experimental parameters enable the effective separation of the OSL signal originating from different traps. The consequences of such an approach to optical stimulation will be presented using the modelling of the OSL process and compared with experimental results.

Peak systolic velocity of tricuspid annulus is inferior to tricuspid annular plane systolic excursion for 30 days prediction of adverse outcome in acute pulmonary embolism.

BACKGROUND: Tricuspid annular plane systolic excursion (TAPSE) is an established index of right ventricular (RV) systolic function and a significant predictor in normotensive patients with pulmonary embolism (PE). Recently, Doppler tissue imaging-derived tricuspid annular systolic velocity (TV S'), a modern parameter of RV function was reported to be useful in the diagnosis and prognosis of a broad spectrum of heart diseases. Therefore, herein, is an analysis of the prognostic value of both parameters in normotensive PE patients. METHODS: One hundred and thirty nine consecutive PE patients (76 female, age 56.4 ± 19.5 years) were included in this study. All patients were initially anticoagulated. Transthoracic echocardiography was performed on admission. The study endpoint (SE) was defined as PE-related 30-day mortality and/or need for rescue thrombolysis. RESULTS: Seven (5%) patients who met the criteria for SE presented more severe RV dysfunction at echocardiography. Univariable Cox regression analysis showed that RV/LV ratio predicted SE with hazard risk (HR) 10.6 (1.4-80.0; p = 0.02); TAPSE and TV S' showed HR 0.77 (0.67-0.89), p < 0.001, and 0.71 (0.52-0.97), p = 0.03, respectively. Area under the curve for TAPSE in the prediction of SE was 0.881; 95% CI 0.812-0.932, p = 0.0001, for TV S' was 0.751; 95% CI 0.670-0.820, p = 0.001. Multivariable analysis showed that the optimal prediction model included TAPSE and systolic blood pressure (SBP showed HR 0.89 95% CI 0.83-0.95, p < 0.001 and TAPSE HR 0.67, 95% CI 0.52-0.87, p<0.03). Kaplan-Meier analysis showed that initially PE patients with TAPSE ≥ 18 mm had a much more favorable prognosis that patients with TAPSE < 18 mm (p < 0.01), while analysis of S' was only of borderline statistical significance. CONCLUSIONS: It seems that TV S' is inferior to TAPSE for 30 day prediction of adverse outcome in acute pulmonary embolism.

D-dimer levels enhance the discriminatory capacity of bleeding risk scores for predicting in-hospital bleeding events in acute pulmonary embolism.

INTRODUCTION: Bleeding is a major complication of anticoagulation in acute pulmonary embolism (APE) while estimating individual bleeding risk remains challenging. Elevated D-dimer levels (DD) have been shown to predict bleeding events. OBJECTIVES: (1) direct comparison of the capacity of bleeding risk prediction scores (VTE-BLEED, RIETE, HAS-BLED, HEMORR2HAGES) to prognosticate in-hospital bleeding events in the acute phase of APE in a real-life population of APE patients;(2) augmentation of the discriminative capacity of fore mentioned scores with DD. MATERIALS: Post-hoc analysis of a prospective observational study. DD levels were measured using the VIDAS D-dimer Exclusion test. Receiver operating characteristic curves, areas under the curve (AUC) for bleeding prediction were calculated for scores and DD. Bleeding scores+DD were compared using an established index quantifying the reclassification of patients (net reclassification index, NRI). RESULTS: 310 APE patients were included. 35(11.3%) bleeding events occurred (hematomas, GI, urinary tract, retroperitoneal, uterine, CNS, respiratory tract): 17 major (MB) and 18 clinically-relevant non-major bleedings (CRNMB), none were fatal. All scores had satisfactory AUCs (0.754-0.767), except HAS-BLED (AUC = 0.512; 0.455-0.569). DD were higher in patients with bleeding events (29,911 ng/ml vs. 4805 ng/ml, p = .031), AUC 0.621(0.520-0.721), p = .02. DD = 5750 ng/ml was characterized by OR = 2.3(95%CI 1.05-5.0) for all bleeding events. Adding DD improved the discriminatory capacity of tested scores in the non-high risk of bleeding category, NRI 0.07-03. CONCLUSIONS: Of the tested scores RIETE, HEMORR2HAGES, VTE-BLEED performed best at identifying APE patients at risk of in-hospital bleeding complications. DD levels may predict in-hospital bleeding events and may improve identifying patients classified as non-high risk who experience bleeding complications.

A deceptive case of emphysematous cholecystitis complicated with retroperitoneal gangrene and emphysematous pancreatitis: clinical and computed tomography features.

PURPOSE: Emphysematous cholecystitis (EC) is an uncommon, severe variant of acute cholecystitis caused by gas- forming bacteria - most often Clostridium perfringens and Escherichia coli. We present a deceptive case of EC associated with retroperitoneal gas gangrene and emphysematous pancreatitis. CASE REPORT: An 86-year-old, overweight woman was admitted to the emergency department with non-specific abdominal symptoms. Admission laboratory tests showed elevated diastase levels indicating acute pancreatitis. Computed tomography (CT) demonstrated a substantial amount of gas in the retroperitoneum and peritoneal cavity, which raised a suspicion of duodenal perforation. Primary diagnosis was not confirmed during emergency laparotomy, which revealed a gangrenous gallbladder adjacent to the duodenum and surrounded by purulent fluid. The final diagnosis established after laparotomy and rereading of CT scans was that of emphysematous cholecystitis associated with gangrenous pancreatitis and retroperitoneal gangrene. After surgery, the patient was transferred to the intensive care unit in septic shock. Shortly after, the second laparotomy was undertaken on suspicion of internal bleeding. During surgery, the patient experienced cardiac arrest and died despite immediate resuscitation. CONCLUSIONS: Emphysematous cholecystitis may be associated with a spread of infection both to the peritoneal cavity and retroperitoneum and result in a substantial amount of gas in those anatomic compartments. The knowledge of this rare complication may be helpful in establishing a correct diagnosis.

Advances in Imaging of Hip Osteoarthritis.

Osteoarthritis is the most common musculoskeletal disease worldwide, generating enormous social and medical costs. In recent years, research shedding new light on the etiology and pathogenesis of osteoarthritis has been closely related to innovations in diagnostic imaging. Precise visualization of all joint structures affected by osteoarthritis is critical for early detection and assessment of the prognosis and response to treatment. The purpose of this paper is to present recent advances in the imaging of hip osteoarthritis.

Investigation on thermally assisted optically stimulated luminescence (TA - OSL) signal in various sodium chloride samples.

Sodium chloride (NaCl) is a phosphor with potential significance in retrospective dosimetry and geological dating. NaCl has been extensively studied for practical use in OSL dosimetry, however, the exact mechanism of the OSL emission is not well explained. This work attempts to extend the information on NaCl luminescent properties by establishing the occurrence of very deep traps in NaCl using the thermally assisted OSL (TA - OSL) method. The studied material was sodium chloride in different forms: halite minerals from Klodawa salt mine in Poland and NaCl in chemically pure form. The isothermal TA - OSL signal was measured at various temperatures between 25 °C and 280 °C after a prior irradiation and TL erasing of shallow and main traps. The appearance of a strong TA - OSL signal indicates the occurrence of very deep traps in all forms of investigated salt. The temperature dependence of TA - OSL was determined and the activation energy for thermal assistance corresponding to deep traps in NaCl was estimated. For selected temperatures of TA - OSL readout (200 °C and 280 °C) the dose response was examined in wide dose range (1-1000 Gy). Sublinearity was found in different dose range depending on the type of samples.