Development of a Web Database System for a Comprehensive Hypertension Management Program in the Primary Health Care Setting of Urban Areas of Peru.

OBJECTIVES: The objective of this case report is to introduce the development process, structure, characteristics, and effectiveness of the web database (DB) system developed for the hypertension management program in the primary health care setting in the low-income urban areas of Peru. METHODS: A Korean research team cooperated with a Peruvian IT startup company to develop a web DB system to improve the data management of the hypertension management program. The entire web application infrastructure was hosted using the Amazon Web Service. Two different web platforms were established for the user groups of health workers and researchers (program managers). RESULTS: A total of 2,827 program participants were registered in the web DB system until December 2017. Health professionals can input the participant data while providing consultation to the program participants, and the data is accumulated in the web DB in real time. Input errors or data loss is prevented by setting restrictions in the data entry system. During the 4-year project period, 7,696 hours of working time and USD 39,536.48 for data management were saved as the result of web DB system utilization. CONCLUSIONS: The developed web DB system contributed to improve the health condition of the health program participants by providing necessary information to the health professionals at the right time. This case report could be a reference for other researcher to develop web databases for their own context, especially in developing countries.

Ceftazidime/Avibactam for Refractory Bacteremia, Vertebral Diskitis/Osteomyelitis with Pre-Vertebral Abscess and Bilateral Psoas Pyomyositis Secondary to Klebsiella Pneumoniae Carbapenemase-Producing Bacteria (KPC).

A 36-year-old man was admitted to the intensive care unit due to diabetic ketoacidosis and pneumonia requiring mechanical ventilation. Three weeks after admission, he developed a refractory bacteremia with Klebsiella pneumoniae carbapenemase-producing bacteria (KPC). He remained febrile and with bacteremia for six weeks despite therapy with polymyxin B, carbapenems, and amikacin. Imaging studies looking for deep-seated infection revealed vertebral L1-L2 diskitis and osteomyelitis with pre-vertebral abscess and bilateral psoas pyomyositis that were not amenable for drainage. In view of the refractory infection and the activity against KPC described in the literature, we decided to switch the patient to ceftazidime/avibactam. After six weeks of therapy, there was complete resolution of the infectious processes. We present an instance of clinical success with ceftazidime/avibactam for the treatment of refractory KPC bacteremia, vertebral diskitis and osteomyelitis with pre-vertebral abscess and bilateral psoas pyomyositis. This experience serves as reference to support treatment with ceftazidime/avibactam in similar complicated cases.

Imaging of Kienböck disease.

OBJECTIVE: The purpose of this article is to provide an overview of Kienböck disease focusing on imaging findings, including the relevant anatomy, pathophysiology, and treatment of Kienböck disease and the differential diagnoses (pseudo-Kienböck lesions). CONCLUSION: Kienböck disease is a condition marked by avascular necrosis of the lunate bone. MRI is useful in diagnosis and staging and should be considered, after conventional radiography, for patients with suspected Kienböck disease.

Temporal bone trauma and the role of multidetector CT in the emergency department.

The temporal bone anatomy is complex, with many critical structures in close association with one another. The temporal bone region comprises cranial nerves V, VI, VII, and VIII; vascular structures such as the internal carotid and middle meningeal arteries; sigmoid sinus; jugular bulb; and sensorineural and membranous structures of the inner ear. Most temporal bone fractures are a result of high-energy blunt head trauma. Multidetector computed tomography (CT) plays a fundamental role in the initial evaluation of patients with polytrauma in the emergency department. Multidetector CT may help identify important structural injuries that may have devastating complications such as sensorineural hearing loss, conductive hearing loss, dizziness and balance dysfunction, perilymphatic fistulas, cerebrospinal fluid leaks, facial nerve paralysis, and vascular injury. Although classifying temporal bone fractures helps physicians understand and predict trauma-associated complications and guide treatment, identifying injury to critical structures is more important for guiding management and determining prognosis than is simply classifying temporal bone fractures into a general category. Many temporal bone fractures and complications may be readily identified and characterized at routine cervical, maxillofacial, and head multidetector CT performed in patients with polytrauma, without the need for dedicated temporal bone multidetector CT. Dedicated temporal bone multidetector CT should be considered when there is a high degree of suspicion for temporal bone fractures and no fractures are identified at head, cervical, or maxillofacial CT.

Multidetector CT evaluation of calcaneal fractures.

As the largest tarsal bone and the most inferior bone in the body, the calcaneus is responsible for supporting the axial load from the weight of the body. It is most commonly fractured after a fall from a height in which axial loads exceed its support capacity. Calcaneal fractures account for 60% of all tarsal fractures. Conventional radiography is commonly used for initial evaluation of calcaneal injury but has the typical disadvantages of two-dimensional imaging. Modern assessment of calcaneal fractures relies heavily on multidetector computed tomography (CT), which allows better visualization and characterization of fracture lines and fragment displacement. Calcaneal fractures observed at CT have been divided into intra- and extraarticular fractures on the basis of subtalar joint involvement. The Sanders classification system for intraarticular fractures is the most commonly used system because it correlates with clinical outcomes and involves less interobserver variability. The classification of extraarticular fractures has been less controversial and makes use of anatomic landmarks on the calcaneus to divide the bone into anterior, middle, and posterior areas. Soft-tissue involvement is an important aspect of calcaneal fracture assessment because it has been linked with poor functional outcomes. Familiarity with the normal anatomy of the calcaneus, the classification of calcaneal fractures, and the various complications of these fractures is essential for treatment assessment, especially if surgical intervention is required.

Incidental enchondromas of the knee.

OBJECTIVE: The purpose of our study was to determine the prevalence of incidental enchondromas on routine MR knee imaging. MATERIALS AND METHODS: We retrospectively reviewed 449 consecutive routine knee MR examinations for the presence of enchondromas. MRI was considered positive when a focal geographic area of lobular marrow replacement (nonsubchondral) was identified on T1 weighting and high signal intensity was seen on T2 weighting. Patients with enchondromas were further evaluated for demographics; lesion site, size, and relationship to the physeal plate; aggressive imaging features described with chondrosarcoma; concurrent internal derangement; and study indication. RESULTS: The prevalence of incidental enchondromas was 2.9% on routine knee MR examinations. The prevalence was highest in the distal femur (2.0%), followed by the proximal tibia (0.7%) and the proximal fibula (0.2%). The average lesion size was 1.9 x 1.2 x 1.3 cm (57% of lesions were < 1 cm). Most lesions were located in the metaphysis (71%) or diaphysis (21%). Enchondromas were within 1.5 cm of the physeal plate in 72% of cases. No aggressive imaging features to suggest chondrosarcoma were seen. All patients had evidence of internal derangement as the cause of symptoms and the request for imaging. CONCLUSION: Incidental enchondromas can be identified on 2.9% of routine MR knee examinations, most frequently in the distal femur (2.0%). This significant prevalence is much higher than in an autopsy series (0.2%), likely reflecting the increased sensitivity of MRI for detecting small lesions, and is important to recognize to avoid confusion with other pathologic entities.

Imaging of synovial chondromatosis with radiologic-pathologic correlation.

Primary synovial chondromatosis represents an uncommon benign neoplastic process with hyaline cartilage nodules in the subsynovial tissue of a joint, tendon sheath, or bursa. The nodules may enlarge and detach from the synovium. The knee, followed by the hip, in male adults are the most commonly involved sites and patient population. The pathologic appearance may simulate chondrosarcoma because of significant histologic atypia, and radiologic correlation to localize the process as synovially based is vital for correct diagnosis. Radiologic findings are frequently pathognomonic. Radiographs reveal multiple intraarticular calcifications (70%-95% of cases) of similar size and shape, distributed throughout the joint, with typical "ring-and-arc" chondroid mineralization. Extrinsic erosion of bone is seen in 20%-50% of cases. Computed tomography (CT) optimally depicts the calcified intraarticular fragments and extrinsic bone erosion. Magnetic resonance (MR) imaging findings are more variable, depending on the degree of mineralization, although the most common pattern (77% of cases) reveals low to intermediate signal intensity with T1-weighting and very high signal intensity with T2-weighting with hypointense calcifications. These signal intensity characteristics on MR images and low attenuation of the nonmineralized regions on CT scans reflect the high water content of the cartilaginous lesions. CT and MR imaging depict the extent of the synovial disease (particularly surrounding soft-tissue involvement) and lobular growth. Secondary synovial chondromatosis can be distinguished from primary disease both radiologically (underlying articular disease and fewer chondral bodies of variable size and shape) and pathologically (concentric rings of growth). Treatment of primary disease is surgical synovectomy with removal of chondral fragments; recurrence rates range from 3% to 23%. Malignant transformation to chondrosarcoma is unusual (5% of cases) and, although difficult to distinguish from benign disease, is suggested by multiple recurrences and marrow invasion. Recognizing the appearances of primary synovial chondromatosis, which reflect their underlying pathologic characteristics, improves radiologic assessment and is important to optimize patient management.

Primary tumors of the osseous spine.

Primary tumors of the spine are less frequent than metastatic disease, multiple myeloma, and lymphoma. MR imaging is commonly used to evaluate the spine in patients presenting with pain and can further characterize lesions that may be encountered on other imaging studies, such as radiographs, bone scintigraphy, or CT. This article guides radiologists in identifying these lesions and referring physicians to the appropriate patient evaluation. It also offers directions for avoiding all-encompassing broad differential diagnosis lists in situations where the clinical scenario or specific imaging features can significantly limit the diagnostic possibilities.