[Femoral neck stress fractures]. / Stressfracturen van de heup.

Femoral neck stress fractures are relatively rare and caused by repetitive high pressure on the bone with insufficient time to recover. These fractures are often seen in fanatic runners or military personnel, who cover great distances. Patients with a femoral neck stress fracture present with mild pain at the front of the thigh or groin. Radiological imaging includes a plain X-ray and/or MRI-scan. Differentiation between a tension- and compression type stress fracture is important, since their treatment strategies differ. Generally, tension type fractures are unstable and demand operative fixation. Compression type fractures can be treated non-operatively if the fracture is smaller than 50% circumferential of the femoral neck.

Bronchiectasis in Severe Asthma: Does It Make a Difference?

BACKGROUND: Asthma and bronchiectasis are 2 heterogeneous diseases that frequently coexist, particularly in severe asthma. Recognition of this co-diagnosis may importantly affect treatment decisions and outcome. Previous studies in asthma with bronchiectasis show inconsistent outcomes, probably due to the heterogeneity of the included asthma cohorts. OBJECTIVES: We hypothesized that bronchiectasis contributes to asthma severity and that patients with severe asthma and bronchiectasis present with distinct characteristics resulting in different treatable traits. In addition, we explored whether bronchiectasis in severe asthma is more common in a specific phenotype. METHODS: This is a single-center study consecutively including patients with severe asthma from a tertiary referral center. Severe asthma was diagnosed according to the ATS/ERS guidelines. Asthma and infectious exacerbations were defined by the attending specialist as respiratory symptoms requiring treatment with systemic steroids or antibiotics, respectively. Two independent blinded radiologists evaluated each CT. RESULTS: 19% of patients with severe asthma showed bronchiectasis on CT. Patients with bronchiectasis had a lower FEV1% predicted (p = 0.02) and FEV1/FVC (p = 0.004) and more infectious exacerbations (p = 0.003) compared to patients without bronchiectasis. Bronchiectasis is more common in patients with a longer duration of asthma, sensitization to A. fumigatus or a positive sputum culture. Sputum cultures of patients with severe asthma and bronchiectasis revealed more P. aeruginosa, S. maltophilia, H. parainfluenzae, and A. fumigates compared to the non-bronchiectasis group. The adult-onset, eosinophilic asthma phenotype showed the highest prevalence of bronchiectasis (29.4%). CONCLUSIONS: Patients with severe asthma and coexisting bronchiectasis were found to represent a distinct group, in terms of disease severity, microbiology, and asthma phenotype. Performing (HR)CT and sputum cultures can help to identify these patients. These results can possibly contribute to early recognition and targeted treatment of this patient group.

Is fat suppression in T1 and T2 FSE with mDixon superior to the frequency selection-based SPAIR technique in musculoskeletal tumor imaging?

OBJECTIVE: To determine the image quality of fast spin echo (FSE) with mDixon relative to spectral attenuated inversion recovery (SPAIR) FSE sequences in musculoskeletal tumor imaging on a 1.5-T MRI system. MATERIALS AND METHODS: In a HIPAA-compliant prospective study, 265 patients requiring musculoskeletal tumor MRI scans were included. Patient consent was waived by the medical ethical committee. Two radiologists compared SPAIR and mDixon FSE water-only images in both T2- and T1-weighted gadolinium-enhanced (T1-Gd) sequences using a five-point scale (paired samples t test and visual grading characteristics curves (VGC)). Homogeneity of fat suppression, noise, contrast, several artifacts (motion, phase, edge blurring and water-fat swap) and subjective preference were evaluated. RESULTS: Readers did not have subjective preference for either sequence in 71% and 55% (reader 1 and 2, respectively). Scores for homogeneous fat suppression were significantly (p < 0.01) higher for mDixon (4.88 in T2 and 4.87 in T1-Gd) than for SPAIR (4.31 for T2 and 4.21 for T1-Gd). All VGC curves for homogeneity demonstrated preference for mDixon. In 57 individual mDixon cases, fat-suppression homogeneity was strikingly better (≥ 2 points higher), namely in areas with field heterogeneity. Average noise and contrast scores were slightly higher for mDixon, as were motion artifact scores for SPAIR (< 0.5 points difference). CONCLUSIONS: mDixon fat suppression was significantly more homogeneous than SPAIR on both T2 and T1-Gd FSE images in musculoskeletal tumor protocols. In areas of field inhomogeneity, mDixon outperforms SPAIR. SPAIR had slightly less motion artifacts than mDixon.

Unilateral reversible posterior leukoencephalopathy syndrome after coiling of an aneurysm.

BACKGROUND: Reversible posterior leukoencephalopathy syndrome (RPLS) is radiologically characterized by symmetrical subcortical areas of vasogenic edema that are preferentially parieto-occipital, and it typically resolves after appropriate treatment. CASE REPORT: We present a patient with strikingly unilateral RPLS that developed 21 days after coiling of an anterior communicating artery aneurysm and several days of triple-H therapy. Cortical and subcortical vasogenic edema and enhancement developed only in the left hemisphere, with a pattern suggesting RPLS. After 7 months the lesions had nearly completely resolved. CONCLUSIONS: The pathophysiological mechanism underlying RPLS is still not well understood, which makes it difficult to explain the unilateral appearance in this case. Since the imaging findings may be confused with other conditions such as ischemia, recognition of RPLS after coiling is necessary in order to avoid inadequate treatment.

Resizable ventricular patch plasty in the porcine left ventricle: a pilot study.

OBJECTIVE: : Endoventricular circular patch plasty is a method used to reconstruct the ventricular cavity in patients with (post) ischemic left ventricular aneurysm or global dilatation. However, late redilatation with mitral regurgitation has been reported, in which postoperative apex shape seems to play an important role. We studied the feasibility of ventricular volume downsizing with a variably shaped patch in porcine hearts. METHODS: : In five in vitro and two acute animal experiments, a dyskinetic aneurysm was simulated with a pericardial insert. Reducing patch surface by changing patch shape diminished end-diastolic volume. In vitro, static end-diastolic volume was determined for each patch shape using volumetry and echocardiography. In the acute animal experiments, preliminary observations of patch behavior in live material were made, and pressure/time relationship, dPdTmax, was registered. RESULTS: : In vitro, bringing the convex patch into a flat plane reduced LV volume from 66 ± 7 mL (aneurysm) to 49 ± 5 mL. Four of 5 patch shapes further reduced volume to a mean of 38 ± 7 mL (P = 0.03). The in vitro echocardiographic measurements correlated with volumetry findings (r = 0.81). In the acute animal experiments, dPdTmax varied with patch shape, independent of volume changes. CONCLUSIONS: : In this pilot study, in vitro shape configuration of the resizable ventricular patch resulted in a calibrated end-diastolic volume reduction. The data of the two in vivo pilot experiments clearly indicate that change in patch configuration in the situation of more or less unchanged end-diastolic volume had impact on cardiac performance. Future studies must substantiate the results of this observation.