RESUMEN
We report a case of descending necrotizing mediastinitis (DNM) in a 68-year-old male who presented in acute respiratory distress accompanied with anterior cervical neck swelling and pain with swallowing. Contrast enhanced computed tomography (CECT) of the neck demonstrated a large, peripherally enhancing retropharyngeal fluid and air collection that appeared to communicate with a fluid and air collection within the mediastinum. CECT of the chest demonstrated punctate foci of air and fat stranding along the anterior and superior mediastinum. Radiological evidence and the presence of necrosis on surgical debridement of the retropharyngeal abscess established the diagnosis of DNM. This case emphasizes the role of computed tomography (CT) in the diagnosis of DNM and demonstrates the utility of chest imaging in a high-risk patient who presents with a retropharyngeal abscess.
Asunto(s)
Mediastinitis , Absceso Retrofaríngeo , Anciano , Humanos , Masculino , Drenaje , Mediastinitis/diagnóstico por imagen , Mediastinitis/etiología , Mediastinitis/cirugía , Cuello/diagnóstico por imagen , Necrosis/complicaciones , Radiografía , Absceso Retrofaríngeo/complicaciones , Absceso Retrofaríngeo/diagnóstico por imagen , Absceso Retrofaríngeo/cirugía , Tomografía Computarizada por Rayos XRESUMEN
PURPOSE: To assess the impact of surgical approach on morbidity, mortality, and the oncological outcomes of synchronous (SC) and metachronous (MC) colorectal cancer (CRC). METHODS: All patients undergoing resection for double location CRC (SC or MC) between 2006 and 2020 were included. The exclusion criteria were polyposis or SC located on the same side. RESULTS: Sixty-seven patients (age, 64.8 years; male, 78%) with SC (n = 41; 61%) or MC (n = 26; 39%) were included. SC was treated with segmental colectomy (right and left colectomy/proctectomy; n = 19) or extensive colectomy (subtotal/total colectomy or restorative proctocolectomy with pouch; n = 22). Segmental colectomy was associated with a higher incidence of anastomotic leakage (47.4 vs. 13.6%; p = 0.04) and a higher rate of medical morbidity (47.4 vs. 16.6%; p = 0.04). The mean number of lymph nodes harvested was similar. For MC, the second cancer was treated by iterative colectomy (n = 12) or extensive colectomy (n = 14) and there was no significant difference in postoperative outcomes between the two surgical approaches. The median follow-up period was 42.4 ± 29.1 months. The 5-year overall and disease-free survival of the SC and MC groups did not differ to a statistically significant extent. CONCLUSIONS: Extensive colectomy should be preferred for SC to reduce morbidity and improve the prognosis. In contrast, iterative colectomy can be performed safely for patients with MC.
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Neoplasias Colorrectales Hereditarias sin Poliposis , Neoplasias Colorrectales , Neoplasias Primarias Secundarias , Proctocolectomía Restauradora , Humanos , Masculino , Persona de Mediana Edad , Colectomía , Neoplasias Colorrectales/cirugía , Neoplasias Primarias Secundarias/cirugía , Estudios RetrospectivosRESUMEN
BACKGROUND: Spinal manipulative therapy (SMT) is frequently used to manage cervicogenic headache (CGHA). No meta-analysis has investigated the effectiveness of SMT exclusively for CGHA. OBJECTIVE: To evaluate the effectiveness of SMT for CGHA. DATABASES AND DATA TREATMENT: Five databases identified randomized controlled trials comparing SMT with other manual therapies. The PEDro scale assessed the risk-of-bias. Pain and disability data were extracted and converted to a common scale. A random effects model was used for several follow-up periods. GRADE described the quality of evidence. RESULTS: Seven trials were eligible. At short-term follow-up, there was a significant, small effect favouring SMT for pain intensity (mean difference [MD] -10.88 [95% CI, -17.94, -3.82]) and small effects for pain frequency (standardized mean difference [SMD] -0.35 [95% CI, -0.66, -0.04]). There was no effect for pain duration (SMD - 0.08 [95% CI, -0.47, 0.32]). There was a significant, small effect favouring SMT for disability (MD - 13.31 [95% CI, -18.07, -8.56]). At intermediate follow-up, there was no significant effects for pain intensity (MD - 9.77 [-24.21 to 4.68]) and a significant, small effect favouring SMT for pain frequency (SMD - 0.32 [-0.63 to - 0.00]). At long-term follow-up, there was no significant effects for pain intensity (MD - 0.76 [-5.89 to 4.37]) and for pain frequency (SMD - 0.37 [-0.84 to 0.10]). CONCLUSION: For CGHA, SMT provides small, superior short-term benefits for pain intensity, frequency and disability, but not pain duration, however, high-quality evidence in this field is lacking. The long-term impact is not significant. SIGNIFICANCE: CGHA are a common headache disorder. SMT can be considered an effective treatment modality, with this review suggesting it providing superior, small, short-term effects for pain intensity, frequency and disability when compared with other manual therapies. These findings may help clinicians in practice better understand the treatment effects of SMT alone for CGHA.
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Manipulación Espinal , Cefalea Postraumática , Humanos , Cefalea Postraumática/terapia , Resultado del TratamientoRESUMEN
A case of a 32-year-old female with a known diagnosis of Turner syndrome who presented with complaints of chronic progressive right-sided facial pain and sinus pressure and who was afebrile. On physical examination, there was eye proptosis on the right and significant increased fullness in the right infraorbital and maxillary regions. Computed tomography and magnetic resonance imaging demonstrated a large expansile space-occupying lesion in the right maxillary area that histologically turned out to be a giant cell reparative granuloma. The lesion was completely removed, and of interest, the patient was followed up both clinically and on imaging for 10 years with no signs of recurrence. A discussion on this entity, as well the clinical and imaging differential diagnoses, is discussed.
Asunto(s)
Granuloma de Células Gigantes/diagnóstico , Enfermedades de los Senos Paranasales/diagnóstico , Adulto , Diagnóstico Diferencial , Femenino , Estudios de Seguimiento , Humanos , Seno Maxilar/patologíaRESUMEN
This is a case of a 32-year-old female with a known diagnosis of Turner syndrome who presented with complaints of chronic progressive right-sided facial pain and sinus pressure, and who was afebrile. On physical examination, there was eye proptosis on the right and significant increased fullness in the right infraorbital and maxillary regions. Computed tomography and magnetic resonance imaging demonstrated a large expansile space-occupying lesion in the right maxillary area, that histologically turned out to be a giant cell reparative granuloma. The lesion was completely removed and of interest, the patient was followed up both clinically and on imaging for 10 years with no signs of recurrence. A discussion on this entity, as well the clinical and imaging differential diagnoses, is carried out.
Asunto(s)
Granuloma de Células Gigantes/diagnóstico por imagen , Enfermedades Maxilares/diagnóstico por imagen , Adulto , Exoftalmia/etiología , Femenino , Estudios de Seguimiento , Granuloma de Células Gigantes/complicaciones , Granuloma de Células Gigantes/cirugía , Humanos , Imagen por Resonancia Magnética , Enfermedades Maxilares/complicaciones , Enfermedades Maxilares/cirugía , Tomografía Computarizada por Rayos X , Síndrome de Turner/complicacionesAsunto(s)
Malformaciones Vasculares del Sistema Nervioso Central/complicaciones , Espasmo Hemifacial/etiología , Síndromes de Compresión Nerviosa/etiología , Arteria Vertebral/diagnóstico por imagen , Malformaciones Vasculares del Sistema Nervioso Central/diagnóstico por imagen , Nervio Facial , Humanos , Angiografía por Resonancia Magnética , Masculino , Persona de Mediana Edad , Síndromes de Compresión Nerviosa/diagnóstico por imagenRESUMEN
Osmotic demyelination syndrome (ODS) is a general term that has become commonplace in the practice of medicine, encompassing both central pontine myelinolysis and extrapontine myelinolysis. Historically ODS arises as a serious complication of rapid correction of hyponatremia, yet its manifestations seem to be influenced by a multifactorial process. Further understanding of this rare demyelinating disease has elucidated the significant role of other electrolyte disturbances and the presence of chronic comorbidities as disease risk factors. This review discusses the current research regarding the pathophysiology, clinical manifestations, neuroimaging features, patient management, and prognosis of osmotic demyelination syndrome. We hope that this review will further endorse and aid in the proper diagnosis of ODS and its suitable management through the understanding of clinical and imaging correlations and outcomes, and the comorbid factors that may predispose the development of ODS in certain patient populations.
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Comorbilidad , Hiponatremia/tratamiento farmacológico , Imagen por Resonancia Magnética/métodos , Mielinólisis Pontino Central/diagnóstico por imagen , Terapia Combinada , Femenino , Escala de Coma de Glasgow , Humanos , Hiponatremia/diagnóstico , Incidencia , Masculino , Persona de Mediana Edad , Mielinólisis Pontino Central/mortalidad , Mielinólisis Pontino Central/fisiopatología , Mielinólisis Pontino Central/terapia , Neuroimagen/métodos , Pronóstico , Índice de Severidad de la Enfermedad , Tasa de Supervivencia , SíndromeRESUMEN
A 36-year-old woman presents to the emergency department with a 4-day history of progressive lower abdominal pain accompanied by nausea.
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Adenocarcinoma/diagnóstico , Enfermedades del Íleon/diagnóstico por imagen , Válvula Ileocecal/diagnóstico por imagen , Intususcepción/diagnóstico por imagen , Adulto , Colonoscopía , Femenino , Humanos , Enfermedades del Íleon/etiología , Enfermedades del Íleon/cirugía , Válvula Ileocecal/cirugía , Intususcepción/etiología , Intususcepción/cirugía , Imagen Multimodal , Tomografía Computarizada por Rayos XRESUMEN
Few cases of primary mucosal melanoma of the larynx have been documented in the literature, so only a limited amount of data exists regarding its diagnosis and treatment. The prognosis is poor, as patients often present at a late stage with regional or distant metastases. We describe the case of a 66-year-old man who presented with hoarseness and dysphagia. Laryngoscopy identified a dark discoloration of the supraglottic larynx and incomplete mobility of the right vocal fold; an excisional biopsy confirmed the diagnosis. We discuss the epidemiology, clinical features, diagnosis, interpretation of imaging findings, and management of this rare malignant melanoma.
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Neoplasias Laríngeas/patología , Melanoma/patología , Anciano , Trastornos de Deglución/etiología , Ronquera/etiología , Humanos , Mucosa Laríngea/patología , Neoplasias Laríngeas/complicaciones , Masculino , Melanoma/complicaciones , Enfermedades RarasRESUMEN
An MRI of the brain and spine of an 11-year-old male revealed the following abnormality which is consistent with his chronic condition.
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Errores Innatos del Metabolismo de los Aminoácidos/diagnóstico por imagen , Encéfalo/diagnóstico por imagen , Globo Pálido/diagnóstico por imagen , Anomalías Múltiples , Niño , Humanos , Imagen por Resonancia Magnética , MasculinoRESUMEN
RATIONALE AND OBJECTIVES: The Association of Program Directors in Radiology regularly surveys its members regarding issues of importance to support radiology residency programs and their directors. MATERIALS AND METHODS: This is an observational cross-sectional study using two Web-based surveys posed to the Association of Program Directors in Radiology membership in the fall of 2014 (49 items) and the spring of 2015 (46 items) on the subjects of importance to the members, including the Accreditation Council on Graduate Medical Education Milestones, the Non-Interpretative Skills Curriculum, the American Board of Radiology Core Examination, the effect of the new resident testing and program accreditation paradigms on training outcomes, the 2015 Residency Match, the Interventional Radiology/Diagnostic Radiology (IR/DR) Residency, and Program Director (PD)/Program Coordinator resources. RESULTS: Responses were collected electronically, results were tallied using SurveyMonkey software, and qualitative responses were tabulated or summarized as comments. Findings were reported during the 63rd annual meeting of the Association of University Radiologists. The maximal response rate was 33% in the fall of 2014 and 36% in the spring of 2015. CONCLUSIONS: PDs believed that the radiology Milestones, now largely implemented, did not affect overall resident evaluation, was not reflective of resident experience, and actually made evaluation of residents more difficult. PDs also felt that although the American Board of Radiology oral examination had been a better test for clinical practice preparedness, their new residents knew at least as much as before. There was little evidence of recall reemergence. The radiology training community saw a drop in residency applicant quality as demonstrated by the United States Medical Licensing Examination scores and clinical rotation grades. Because the new IR/DR Residency positions were to be funded at the expense of the traditional DR positions, the majority of PDs expected a negative effect of the impending IR/DR match on their DR recruitment. PDs were in favor of a unified clinical radiology curriculum similar to the Radiological Society of North America online physics modules.
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Actitud del Personal de Salud , Internado y Residencia , Ejecutivos Médicos/psicología , Radiología/educación , Acreditación , Estudios Transversales , Curriculum , Humanos , Encuestas y Cuestionarios , Estados UnidosAsunto(s)
Coristoma/diagnóstico , Neoplasias de Cabeza y Cuello/diagnóstico , Disgenesias Tiroideas/diagnóstico , Neoplasias de la Tiroides/diagnóstico , Coristoma/patología , Diagnóstico Diferencial , Femenino , Neoplasias de Cabeza y Cuello/patología , Humanos , Persona de Mediana Edad , Disgenesias Tiroideas/patología , Neoplasias de la Tiroides/secundarioAsunto(s)
Carcinoma Adenoide Quístico/patología , Neoplasias Pulmonares/secundario , Neoplasias de la Parótida/patología , Carcinoma Adenoide Quístico/diagnóstico por imagen , Humanos , Neoplasias Pulmonares/diagnóstico por imagen , Masculino , Persona de Mediana Edad , Neoplasias de la Parótida/diagnóstico por imagen , Pronóstico , Tomografía Computarizada por Rayos XAsunto(s)
Diplopía/etiología , Enoftalmia/diagnóstico por imagen , Seno Maxilar/diagnóstico por imagen , Enfermedades de los Senos Paranasales/diagnóstico por imagen , Enoftalmia/patología , Femenino , Humanos , Imagen por Resonancia Magnética , Seno Maxilar/patología , Persona de Mediana Edad , Enfermedades de los Senos Paranasales/patología , SíndromeRESUMEN
A 67-year-old female presented to our institution with a progressive history of hoarseness for the past six months. The patient also referred shoulder weakness and cough during the same period of time. She denied weight loss and tobacco use. Past medical history was negative for squamous cell carcinoma of the head and neck region. Physical examination demonstrated asymmetry of the sternocleidomastoid and trapezius muscles. Flexible laryngoscopy was performed and revealed complete unilateral vocal cord paralysis on the right. Magnetic Resonance (MR) of the brain with intravenous contrast (Figure 1) and computer tomography (CT) of soft tissue of the neck with contrast (Figure 2) were performed for further evaluation.
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Enfermedades de los Nervios Craneales , Tomografía Computarizada por Rayos X , Disfunción de los Pliegues Vocales , Anciano , Enfermedades de los Nervios Craneales/complicaciones , Enfermedades de los Nervios Craneales/diagnóstico por imagen , Enfermedades de los Nervios Craneales/fisiopatología , Femenino , Humanos , Disfunción de los Pliegues Vocales/diagnóstico por imagen , Disfunción de los Pliegues Vocales/etiología , Disfunción de los Pliegues Vocales/fisiopatologíaRESUMEN
RATIONALE AND OBJECTIVES: The newly formed Alliance of Directors and Vice Chairs of Education in Radiology (ADVICER), a group within the Alliance for Clinician Educators in Radiology, identified an acute need for a generic job description template for Vice Chairs of Education in Radiology, a role that is being developed in many academic Departments of Radiology. Eighty-three percent of current members who responded to a survey had no detailed job description, and over half had no job description at all. Having a comprehensive and detailed job description is vital to developing this key position. MATERIALS AND METHODS: Using the results of a survey sent to ADVICER members and seven Education Vice Chair job descriptions provided by members, the authors developed a detailed job description encompassing all potential elements of this position. RESULTS: Only 17% of survey respondents had a detailed job description. The role of an Education Vice Chair varies significantly between institutions in its scope and level of responsibilities. The resultant generic job description that was devised is intended to provide a template that would be modified by the candidate or the Department Chair. It is unlikely that any one individual would perform all the described activities. CONCLUSIONS: ADVICER has developed a comprehensive, flexible job description for Vice Chair of Education in Radiology that can be adapted by institutions as appropriate. It can be downloaded from http://aur.org/ADVICER/.