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OBJECTIVE: To identify clinical and biological criteria predictive of significant traumatic injury in only kinetic-based polytrauma patients without clinical severity criteria. To propose a decisional algorithm to assist the emergency doctor in deciding whether or not to perform a WBCT in the above population. METHODS: Retrospective bi-center study. 1270 patients with high velocity trauma without clinical severity criteria, for whom a WBCT was performed in 2017, were included. Patients with hemodynamic, respiratory or neurological severity criterion or those requiring pre-hospital resuscitation measures were excluded. Our primary endpoint was the identification of a significant lesion, i.e. any lesion that led to hospitalization > 24 h for monitoring or medico-surgical treatment. Data collected were age, sex, mechanism of injury, Glasgow Coma Scale score, number of symptomatic body regions, blood alcohol level, and neutrophil count. RESULTS: Multivariate analysis found independent predictors of significant injury: fall > 5 m (OR: 14.36; CI: 2.3-283.4; p = 0.017), Glasgow score = 13 or 14 (OR: 4.40; CI:1.30-18.52; p = 0.027), presence of 2 symptomatic body regions (OR: 10.21; CI: 4.66-23.72; p = 0.05), positive blood alcohol level (OR: 2.81; CI: 1.13-7.33; p = 0.029) and neutrophilic leukocytosis (OR: 8.76; CI: 3.94-21.27; p = 0.01). A composite clinico-biological endpoint predictive of the absence of significant lesion was identified using a Classification and Regression Tree: number of symptomatic regions < 2, absence of Neutrophilic leukocytosis and negative blood alcohol concentration. CONCLUSION: A simple triage algorithm was created with the objective of identifying, in high velocity trauma without clinical severity criteria, those without significant traumatic injury.
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Nivel de Alcohol en Sangre , Traumatismo Múltiple , Humanos , Estudios Retrospectivos , Leucocitosis , Puntaje de Gravedad del Traumatismo , Traumatismo Múltiple/diagnóstico por imagen , Tomografía Computarizada por Rayos XRESUMEN
Background Cardiac MRI features are not well-defined in immune checkpoint inhibitor (ICI)-induced myocarditis (ICI-M), a severe complication of ICI therapy in patients with cancer. Purpose To analyze the cardiac MRI features of ICI-M and to explore their prognostic value in major adverse cardiovascular events (MACE). Materials and Methods In this retrospective study from May 2017 to January 2020, cardiac MRI findings (including late gadolinium enhancement [LGE], T1 and T2 mapping, and extracellular volume fraction [ECV] z scores) of patients with ICI-M were compared with those of patients with cancer scheduled to receive ICI therapy (pre-ICI group) and patients with viral myocarditis. As a secondary objective, the potential value of cardiac MRI for predicting MACE in patients with ICI-M by using Cox proportional hazards models was explored. Results Thirty-three patients with ICI-M (mean age ± standard deviation, 68 years ± 14; 23 men) were compared with 21 patients scheduled to receive to ICI therapy (mean age, 65 years ± 14; 14 men) and 85 patients with viral myocarditis (mean age, 32 years ± 13; 67 men). Compared with the pre-ICI group, patients with ICI-M showed higher global native T1, ECV, and T2 z scores (0.03 ± 0.85 vs 1.79 ± 1.93 [P < .001]; 1.34 ± 0.57 vs 2.59 ± 1.97 [P = .03]; and -0.76 ± 1.41 vs 0.88 ± 1.96 [P = .002], respectively), and LGE was more frequently observed (27 of 33 patients [82%] vs two of 21 [10%]; P < .001). LGE was less frequent in patients with ICI-M than those with viral myocarditis (27 of 33 patients [82%] vs 85 of 85 [100%]; P < .001) but was more likely to involve the septal segments (16 of 33 patients [48%] vs 25 of 85 [29%]; P < .001) and midwall layer (11 of 33 patients [33%] vs two of 85 [2%]; P < .001). Septal LGE was the only cardiac MRI predictor of MACE at 1 year even after adjustment for peak troponin (adjusted hazard ratio, 2.7 [95% CI: 1.1, 6.7]; P = .03). Conclusion Cardiac MRI features of immune checkpoint inhibitor (ICI)-induced myocarditis (ICI-M) seem to differ from those in patients scheduled to receive ICIs and patients with viral myocarditis. Septal late gadolinium enhancement might be a predictor of major cardiovascular events in patients with ICI-M. Clinical trial registration no. NCT03313544 © RSNA, 2022 Online supplemental material is available for this article. See also the editorial by Edelman and Pursnani in this issue.
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Miocarditis , Neoplasias , Adulto , Anciano , Medios de Contraste/efectos adversos , Gadolinio/efectos adversos , Humanos , Inhibidores de Puntos de Control Inmunológico/efectos adversos , Imagen por Resonancia Magnética/métodos , Imagen por Resonancia Cinemagnética , Masculino , Miocarditis/inducido químicamente , Miocarditis/diagnóstico por imagen , Valor Predictivo de las Pruebas , Pronóstico , Estudios RetrospectivosRESUMEN
PURPOSE: Splenic vessel involvement occurs frequently in pancreatic ductal adenocarcinoma (PDAC) of the body and the tail (B/T) but the impact on survival is unknown. We assessed the influence of radiological and pathologic involvement of splenic artery (p-SA +) and vein (p-SV +) on patient outcomes after distal pancreatectomy (DP) for PDAC. METHODS: From 2013 to 2019, all DP for PDAC in five centers were included. Factors associated with overall (OS) and disease-free (DFS) survival were identified. RESULTS: Among the 76 patients included, 5 (6.6%) had p-SA + only, 11 (14.5%) had p-SV + only, and 24 (31.6%) had both p-SA + and p-SV + . The preoperative CT-scan accuracy to predict p-SV + and p-SA + was high (sensitivity: 91.4% and 82.8%, respectively; negative predictive value: 89.7% and 88.3%, respectively). The 5-year OS and DFS rates were 3.9% and 8.3%, respectively. Multivariate analysis identified splenic vessel involvement (i.e., p-SA + or p-SV + , or both p-SA + and p-SV +) as the only independent factor influencing DFS (HR 4.04; 95% CI [1.22-13.44], p = 0.023). Tumor size ≥ 30 mm was the only independent factor influencing OS (HR 4.04; 95% CI [1.26-12.95], p = 0.019) and was associated with a high risk of p-SA + (p = 0.001) and p-SV + (p < 0.001). CONCLUSION: Tumor size ≥ 30 mm and splenic vessel involvement occurred in more than half of the patients who underwent DP for PDAC and had negative impact on long-term survival. Preoperative CT-scan was reliable to identify splenic vessel involvement in B/T PDAC. Large tumor size and radiological splenic vessel involvement could be taken into account to propose a neoadjuvant treatment.
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Adenocarcinoma , Carcinoma Ductal Pancreático , Neoplasias Pancreáticas , Adenocarcinoma/diagnóstico por imagen , Adenocarcinoma/cirugía , Carcinoma Ductal Pancreático/diagnóstico por imagen , Carcinoma Ductal Pancreático/cirugía , Humanos , Pancreatectomía , Neoplasias Pancreáticas/diagnóstico por imagen , Neoplasias Pancreáticas/cirugía , Pronóstico , Estudios RetrospectivosRESUMEN
BACKGROUND: The surgical difficulty and postoperative outcomes of laparoscopic liver resection (LLR) are related to the size of the cut liver surface. This study assessed whether the estimated parenchymal transection surface area could predict intraoperative difficulty and postoperative outcomes. METHODS: LLRs performed between 2008 and 2018, for whom a preoperative CT scan was available for 3D review, were included in the study. The area of scheduled parenchymal transection was measured on the preoperative CT scan and cut-off values that could predict intraoperative difficulty were analyzed. RESULTS: 152 patients who underwent left lateral sectionectomy (n = 27, median estimated area 30.1 cm2 [range 16.6-65.9]), left/right hepatectomy (n = 17 and n = 70, 76.8 cm2 [range 43.9-150.9] and 72.2 cm2 [range 39.4-124.9], respectively), right posterior sectionectomy (n = 7, 113.3 cm2 [range 102.1-136.3]), central hepatectomy (n = 11, 109.1 cm2 [range 66.1-186.1]) and extended left/right hepatectomy (n = 6 and n = 14, 115.3 cm2 [range 92.9-128.9] and 50.7 cm2 [range 13.3-74.9], respectively) were included. An estimated parenchymal transection surface area ≥ 100 cm2 was associated with significant increase in operative time (AUC 0.81, 95% CI [0.70, 0.93], p < 0.001) and estimated blood loss (AUC 0.92, 95% CI [0.86, 0.97], p < 0.001), as well as a higher conversion rate (22.2% vs. 4.0%, p < 0.001). Overall (p = 0.017) and major morbidity (p = 0.003), biliary leakage (p < 0.001) and pulmonary complications (p < 0.001) were significantly higher in patients with an estimated parenchymal transection surface area ≥ 100 cm2. CONCLUSIONS: An estimated parenchymal transection surface area ≥ 100 cm2 is a relevant indicator of surgical difficulty and postoperative complications in LLR.
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Laparoscopía , Neoplasias Hepáticas , Pérdida de Sangre Quirúrgica , Hepatectomía/efectos adversos , Humanos , Neoplasias Hepáticas/diagnóstico por imagen , Neoplasias Hepáticas/cirugía , Tempo Operativo , Complicaciones Posoperatorias/diagnóstico por imagen , Complicaciones Posoperatorias/epidemiología , Complicaciones Posoperatorias/etiología , Tomografía Computarizada por Rayos XRESUMEN
BACKGROUND: Atelectasis frequently occurs early on during anaesthesia in children. We hypothesised that positive expiratory pressure (PEP) generated via high-flow nasal cannula (HFNC) could prevent atelectasis in non-intubated children under general anaesthesia. The objective was to compare the volume of atelectasis present in patients treated via HFNC to that of patients treated via a face bag-mask without PEP. The outcome used for this comparison was the ratio of the atelectasis volume to the total pulmonary volume. METHODS: A prospective single-centre, single-blind, randomised trial was conducted in a tertiary hospital from November 2018 through May 2019. The trial subjects were infants and children between six months and six years of age who required anaesthesia for an MRI. The children were randomised to receive sevoflurane for maintenance of anaesthesia either via a classic face bag-mask or by HFNC. The atelectasis volume was measured from thoracic MRI images. The judgement criterion was the ratio of the atelectasis volume to the lung volume. RESULTS: Of a trial group of 42 patients, 21 received anaesthesia via a face bag-mask and 21 via HFNC. After three patients were excluded for technical issues, the data for 39 patients were analysed. The atelectasis volume to the lung volume ratio in the HFNC group was significantly smaller than the ratio for the face bag-mask group (1.6% vs 6.8%, respectively; p=0.002). CONCLUSION: HFNC was associated with a lower atelectasis lung ratio compared to using a face bag-mask during anaesthesia for children maintained with spontaneous ventilation. Registered on Clinicaltrials.gov: NCT03592589.
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Cánula , Atelectasia Pulmonar , Anestesia General , Niño , Humanos , Lactante , Imagen por Resonancia Magnética , Estudios Prospectivos , Atelectasia Pulmonar/diagnóstico por imagen , Atelectasia Pulmonar/prevención & control , Método Simple CiegoRESUMEN
Isolated cases of acute coronary syndrome (ACS) associated with immune checkpoint inhibitors (ICIs) have been described without the establishment of a formal cause-and-effect relationship between treatment and adverse event. We reported a case of ACS after the first administration of an ICI and with a fatal recurrence in another coronary area immediately after readministration. According to guidelines, causality was considered to be certain. Subsequently, we queried the French pharmacovigilance database and found 4 cases of ACS with coronary artery thrombosis. Causality was probable in those patients. These data suggest that ACS may be another life-threatening cardiac adverse event occurring with ICI exposure.
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Síndrome Coronario Agudo/inducido químicamente , Antineoplásicos Inmunológicos/efectos adversos , Factores Inmunológicos/efectos adversos , Farmacovigilancia , Anciano , Anciano de 80 o más Años , Femenino , Humanos , Masculino , Persona de Mediana Edad , Prueba de Estudio ConceptualRESUMEN
INTRODUCTION: Ventral hernia surgery does not usually account for the individuality of the abdominal wall anatomy. This could be both because medical imaging is rarely performed before surgery and because data on abdominal wall variability are limited. The objective of the present study was to perform an exhaustive morphometric analysis of abdominal wall components based on computed tomography (CT) scans. MATERIALS AND METHODS: A retrospective study was performed on 120 abdominopelvic CT scans of clinically normal adults aged 18-86 years equally divided between women and men and into four age groups. Each abdominal wall muscle was evaluated in terms of area, thickness, shape ratio, fat infiltration, and aponeuroses width. The influence of age, gender, and body mass index (BMI) was investigated, as well as muscular asymmetry. RESULTS: The abdominal wall muscle area represented 8.5 ± 2.5% of the abdominal area. The internal oblique muscle had the largest area, the rectus abdominis was the thickest, the transversus abdominis was the narrowest and had the smallest area. The width of the linea alba was 20.3 ± 12.0 mm. The evolution of the abdominal wall with age was quantified, as well as the large differences between the sexes and BMI groups, resulting in strong correlations and highlighting the specific pattern of the transversus abdominis. The asymmetry of the left and right muscle areas oscillated around 17%. CONCLUSIONS: The various components of the abdominal wall have been precisely described. Knowledge of their variability could be used to enhance the planning of ventral hernia surgery or to develop numerical modeling of the abdominal wall.
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Músculos Abdominales/diagnóstico por imagen , Pared Abdominal/diagnóstico por imagen , Variación Anatómica , Aponeurosis/diagnóstico por imagen , Músculos Abdominales/anatomía & histología , Pared Abdominal/anatomía & histología , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Aponeurosis/anatomía & histología , Índice de Masa Corporal , Femenino , Humanos , Masculino , Persona de Mediana Edad , Valores de Referencia , Estudios Retrospectivos , Tomografía Computarizada por Rayos X , Adulto JovenRESUMEN
OBJECTIVES: The aims of this study were to: 1) analyze the cannula-associated deep vein thrombosis frequency after venovenous extracorporeal membrane oxygenation using a CT scan and 2) identify the associated risk factors for cannula-associated deep vein thrombosis. DESIGN: Retrospective observational analysis at a single center. SETTING: Tertiary referral university teaching hospital. PATIENTS: Patients under venovenous extracorporeal membrane oxygenation with a femorofemoral or femorojugular cannulation admitted for acute respiratory distress syndrome or primary graft dysfunction after pulmonary transplantation. CT scan was performed within 4 days after decannulation. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: We included 105 of 228 patients screened. Bacterial pneumonia was the main indication of venovenous extracorporeal membrane oxygenation (46.7%). CT scans were performed at a median of 2 days (1-3 d) after decannulation. Cannula-associated deep vein thrombosis was found in 75 patients (71.4%) despite it having a mean activated partial thromboplastin time ratio of 1.60 ± 0.31. Femorofemoral cannulation induced femoral cannula-associated deep vein thrombosis more frequently than femorojugular cannulation (69.2% vs 63.1%, respectively; p = 0.04). Seventeen of the 105 patients (16.2%) had a pulmonary embolism. Multivariate logistic regression analysis showed that higher the percentage of thrombocytopenia less than 100 G/L during extracorporeal membrane oxygenation period, lower the risk for developing cannula-associated deep vein thrombosis (hazard ratio, 0.98; 95% CI, 0.98-1.00; p = 0.02). CONCLUSIONS: Cannula-associated deep vein thrombosis after venovenous extracorporeal membrane oxygenation is a frequent complication. This plead for a systematic vascular axis imaging after venovenous extracorporeal membrane oxygenation. Thrombocytopenia is associated with a reduction in the occurrence of thrombotic events.
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Cateterismo/efectos adversos , Oxigenación por Membrana Extracorpórea/efectos adversos , Síndrome de Dificultad Respiratoria/terapia , Trombosis de la Vena/etiología , Adulto , Anciano , Oxigenación por Membrana Extracorpórea/métodos , Femenino , Hospitales de Enseñanza , Humanos , Unidades de Cuidados Intensivos , Masculino , Persona de Mediana Edad , Prevalencia , Síndrome de Dificultad Respiratoria/etiología , Estudios Retrospectivos , Factores de Riesgo , Tomografía Computarizada por Rayos X , Trombosis de la Vena/diagnóstico por imagenRESUMEN
A 46-year-old female patient exhibited massive endobronchial bleeding after dilation of a left bronchial anastomotic stenosis after lung transplantation, consistent with a bronchopulmonary artery fistula (BPAF). The BPAF was treated with a bronchial covered self-expandable metallic stent and percutaneous transcatheter pulmonary artery stent placement. BPAF is rare and leads to death in most cases because of massive hemoptysis. We describe a case of successful combined management of BPAF using both bronchial and pulmonary stent placement.
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Implantación de Prótesis Vascular/métodos , Bronquios/cirugía , Arterias Bronquiales/cirugía , Fístula Bronquial/cirugía , Trasplante de Pulmón/efectos adversos , Complicaciones Posoperatorias , Fístula Vascular/cirugía , Bronquios/diagnóstico por imagen , Arterias Bronquiales/diagnóstico por imagen , Fístula Bronquial/diagnóstico , Fístula Bronquial/etiología , Broncoscopía , Angiografía por Tomografía Computarizada , Femenino , Humanos , Persona de Mediana Edad , Enfisema Pulmonar/cirugía , Fístula Vascular/diagnóstico , Fístula Vascular/etiologíaRESUMEN
OBJECTIVES: The objective of this study was to analyse MRI with morphological (T1, T2) and diffusion sequences (DWI, b1000) in patients presenting non-aggressive patterns of sinus opacity and operated on by functional endoscopic sinus surgery (FESS). DESIGN: A retrospective study. SETTING: Diffusion imaging in paranasal sinus pathology remains little known. To date, no imaging system is capable of determining the purulent content of a non-enhanced sinus filling. PARTICIPANTS: We included consecutive patients having undergone FESS in whom MRI of the paranasal sinuses was performed. Subjects were allocated to Case (pus) or Control (no pus) groups depending on sinus content found intraoperatively. FESS was performed for bacterial acute rhinosinusitis, acute exacerbations of chronic rhinosinusitis, non-purulent sinusitis, naso-sinusal polyposis, antrochoanal polyp, isolated polyp, angiomatous polyp and eosinophilic fungal sinusitis. Tumours, mucoceles and fungus balls were excluded. MAIN OUTCOME MEASURES: We analysed T1, T2, b1000 and MRI sequences and ADC map. RESULTS: On univariate analysis, intermediate signal in T2 and high signal in b1000 were associated with Cases (P < 0.001) as were low ADC values (P < 0.001). The difference in mean ADC values between Cases and Controls was statistically significant (respectively, 0.518 vs 2.041 × 10-3 mm2 /sec, P < 0.01). On multivariate analysis, MRI with ADC < 0.725 × 10-3 mm2 /sec and b1000_SI > brain was significantly associated with the case group. MRI with b1000_SI < brain and ADC > 1.450 × 10-3 mm2 /sec was significantly associated with the control group. CONCLUSIONS: Diffusion MRI offers extremely promising results regarding content characterisation of infectious sinus diseases.
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Imagen de Difusión por Resonancia Magnética/métodos , Enfermedades de los Senos Paranasales/diagnóstico , Senos Paranasales/patología , Femenino , Estudios de Seguimiento , Humanos , Masculino , Persona de Mediana Edad , Procedimientos Quirúrgicos Otorrinolaringológicos/métodos , Enfermedades de los Senos Paranasales/cirugía , Senos Paranasales/cirugía , Reproducibilidad de los Resultados , Estudios RetrospectivosRESUMEN
OBJECTIVES: Cross sectional imaging is mandatory for oral cavity and oropharynx head and neck squamous cell carcinoma's (ooSCC) local extension and TNM staging. However a complex anatomy and frequent dental metallic artifacts make it difficult. This study assesses the clinical benefit of "Mouth Open with Tongue Extended" dynamic maneuver at CT (CTmote) as compared to the conventional CT (CTconv) and MRI. MATERIAL: Retrospectively, 58 patients with histologically proven ooSCC (oral cavity: 34; oropharynx: 24) were included in the study. All had endoscopy with biopsies, MRI, CTconv and an CTmote acquisitions. Data were splitted in 3 datasets and 2 independent radiologists performed readings blindly. Gold standard was pTNM in 31% of cases; otherwise cTNM obtained at multidisciplinary team meeting with endoscopy and mapping biopsies were used. RESULTS: CTmote was feasible for all patients including those already treated by surgery or radiotherapy. Exact TNM staging was obtained in 68%, 83%, 83% for CTconv, CTmote and MRI respectively. The best exam ratings at paired wise comparisons were 3%, 47%, 50% for CTconv, CTmote and MRI respectively. CTmote and MRI observer agreements, image quality and confidence ratings, were comparable and higher compared to CTconv (pâ¯<â¯0.001). CONCLUSIONS: CTmote improves oral cavity and oropharynx tumour stage assessment compared to CTconv with performances close to those of MRI examination. In clinical practice, combining both CT with MOTE maneuver and MRI seems to be the optimal imaging strategy for local staging.
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Imagen por Resonancia Magnética/métodos , Neoplasias de la Boca/diagnóstico por imagen , Estadificación de Neoplasias/métodos , Neoplasias Orofaríngeas/diagnóstico por imagen , Carcinoma de Células Escamosas de Cabeza y Cuello/diagnóstico por imagen , Tomografía Computarizada por Rayos X/métodos , Femenino , Humanos , Masculino , Persona de Mediana Edad , Neoplasias de la Boca/patología , Neoplasias Orofaríngeas/patología , Estudios Retrospectivos , Carcinoma de Células Escamosas de Cabeza y Cuello/patologíaRESUMEN
BACKGROUND: Lung fibroproliferation in ARDS patients is associated with mortality. Alveolar procollagen III (NT-PCP-III) is a validated biomarker of lung fibroproliferation. A chest CT scan could be useful for the diagnosis of lung fibroproliferation. The aim of this study was to identify lung fibroproliferative CT scan aspects in ARDS patients with high levels of NT-PCP-III. RESULTS: This retrospective study included ARDS patients who had at least one assessment of alveolar NT-PCP-III and a chest CT scan within 3 days before or after NT-PCP-III determination. An alveolar level of NT-PCP-III > 9 µG/L indicated fibroproliferation. The CT scan was scored on interstitial and alveolar abnormalities. Each lobe was scored from 0 to 5 according to the severity of the abnormalities. The crude score and the corrected score (related to the number of scored lobes in cases of important lobar condensation or lobectomy) were used. One hundred ninety-two patients were included, for a total of 228 alveolar NT-PCP-III level and CT scan 'couples'. Crude and corrected CT scan fibrosis scores were higher in the fibroproliferation group compared with the no fibroproliferation group (crude score: 12 [9-17] vs 14 [11-12], p = 0.002; corrected score: 2.8 [2.2-4.0] vs 3.4 [2.5-4.7], p < 0.001). CT scan fibrosis scores and NT-PCP-III levels were significantly but weakly correlated (crude score: ρ = 0.178, p = 0.007; corrected score: ρ = 0.184, p = 0.005). CONCLUSIONS: When the alveolar level of NT-PCP-III was used as a surrogate marker of histological lung fibroproliferation, the CT scan fibrosis score was significantly higher in patients with active lung fibroproliferation. Pulmonary condensation is the main limitation to diagnosing fibroproliferation during ARDS.
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We report a case of malignant otitis externa with jugular vein thrombosis caused by Aspergillus flavus. Magnetic resonance imaging revealed an unusual ink smudge pattern deep in a cervical abscess. The pattern was consistent with mycetoma and may be important for diagnosing these life-threatening infections.
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Aspergilosis/complicaciones , Aspergilosis/microbiología , Aspergillus flavus , Venas Yugulares/patología , Otitis Externa/complicaciones , Otitis Externa/microbiología , Trombosis de la Vena/complicaciones , Anciano , Aspergilosis/diagnóstico , Francia , Humanos , Venas Yugulares/diagnóstico por imagen , Imagen por Resonancia Magnética , Masculino , Otitis Externa/diagnóstico , Tomografía Computarizada por Rayos X , Trombosis de la Vena/diagnósticoRESUMEN
Stensen's duct dilation is a rare condition characterized by a global or partial idiopathic dilation of the Stensen duct. Affected individuals usually show either aesthetically compromised features, such as a tubular-shaped swelling in the cheek, or with mildly painful inflammatory episodes. Three women between ages 61 and 67 years were diagnosed with Stensen duct dilation after sialo-magnetic resonance imaging (MRI). They were treated with botulinum toxin A (BTX-A). Our preliminary results suggest that BTX-A was efficient as a suspensive treatment. BTX-A should remain a first-line treatment of the early silent symptoms of Stensen duct dilation, such as swelling and aesthetic issues. The use of BTX-A avoids more serious procedures and further complications.
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Conductos Salivales , Anciano , Toxinas Botulínicas Tipo A , Dilatación , Dilatación Patológica , Estética Dental , Femenino , Humanos , Persona de Mediana EdadRESUMEN
BACKGROUND: 18 F-FDOPA PET/CT was proved to be a highly sensitive imaging method for detecting head and neck paraganglioma (HNPGL). The primary aim of the study was to evaluate the relationship between tumor characteristics and the SDHx-mutational status in a large series of patients with HNPGL evaluated by 18 F-FDOPA PET/CT. METHODS: A total of 104 patients with HNPGL (65 sporadic/39 SDHx-mutated) were included. RESULTS: In comparison to SDHB/SDC/SDHx-negative cases, patients with SDHD were younger at diagnosis and had a higher rate of multifocal, vagal, and carotid paraganglioma. In patients with SDHD, vagal paraganglia represented the primary site of tumor origin. Multicentric involvement of the vagus nerve alone or in association with other locations was found to be a typical feature of SDHD cases compared to other cases (odds ratio = 59.4). CONCLUSION: The present study shows that tumor multifocality within the vagus nerve is a phenotypic marker of SDHD mutation. This information is essential in the choice of the therapeutic strategy.
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Neoplasias de los Nervios Craneales/diagnóstico por imagen , Neoplasias de Cabeza y Cuello/diagnóstico por imagen , Mutación , Paraganglioma Extraadrenal/diagnóstico por imagen , Tomografía Computarizada por Tomografía de Emisión de Positrones , Succinato Deshidrogenasa/genética , Enfermedades del Nervio Vago/diagnóstico por imagen , Factores de Edad , Neoplasias de los Nervios Craneales/genética , Dihidroxifenilalanina/análogos & derivados , Femenino , Radioisótopos de Flúor , Neoplasias de Cabeza y Cuello/genética , Heterocigoto , Humanos , Masculino , Persona de Mediana Edad , Neoplasias Primarias Múltiples , Paraganglioma Extraadrenal/genética , Fenotipo , Estudios Retrospectivos , Nervio Vago/diagnóstico por imagen , Enfermedades del Nervio Vago/genéticaRESUMEN
BACKGROUND: Before total body computed tomography scan, an initial rapid imaging assessment should be conducted in the trauma bay. It generally includes a chest x-ray, pelvic x-ray, and an extended focused ultrasonography assessment for trauma. This initial imaging assessment has been poorly described since the increase in the use of ultrasound. Therefore, our study aimed to evaluate the diagnostic accuracy and therapeutic impact of this initial imaging work-up in severe trauma patients. A secondary aim was to assess the therapeutic impact of a chest x-ray according to the lung ultrasonography findings. METHODS: Patients with severe trauma who were admitted directly to our level 1 trauma center were consecutively included in this retrospective single center study. The diagnostic accuracy, therapeutic impact, and appropriate decision rate were calculated according to the initial assessment results of the whole body computed tomography scan and surgery reports. RESULTS: Among the 1315 trauma patients admitted, 756 were included in this research. Lung ultrasound showed a higher diagnostic accuracy for haemothorax and pneumothorax cases than the chest x-ray. Sensitivity and specificity of the abdominal ultrasound to detect intraperitoneal effusion were 70% and 96%, respectively. The initial assessment had a therapeutic impact in 76 (10%) of the patients, including 16 (2%) immediate laparotomies and 58 (7%) chest tube insertions. The pelvic x-ray had no therapeutic impact, and when the lung ultrasound was normal, the chest x-ray had a therapeutic impact of only 0.13%. Combining the chest x-ray and lung ultrasound allowed adequate management of all the pneumothorax and haemothorax cases. Only one of the 756 patients had initial management that was judged as inappropriate. This patient had a missed pelvic disjunction with active retroperitoneal bleeding, and underwent an inappropriate immediate laparotomy. CONCLUSIONS: In our cohort, the initial imaging assessment allowed appropriate decisions in 755 of 756 patients, with a global therapeutic impact of 10%. The pelvic x-ray had a minimal therapeutic impact, and in the patients with normal lung ultrasounds, the chest x-ray marginally affected the management of our patients. The potential consequences of abandoning systematic chest and pelvic x-rays should be investigated in future randomized prospective studies.
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Traumatismos Abdominales/diagnóstico por imagen , Evaluación Enfocada con Ecografía para Trauma , Traumatismos Torácicos/diagnóstico por imagen , Tomografía Computarizada por Rayos X , Centros Traumatológicos , Ultrasonografía , Imagen de Cuerpo Entero , Adulto , Femenino , Humanos , Puntaje de Gravedad del Traumatismo , Masculino , Traumatismo Múltiple/diagnóstico por imagen , Estudios Retrospectivos , Sensibilidad y EspecificidadRESUMEN
PURPOSE: During Roux-en-Y-gastric Bypass, the limb lengths are preoperatively determined regardless of individual small bowel length (SBL), which presents a great variability. Few studies highlighted anthropometric factors associated with SBL, and none attempted to predict SBL preoperatively. OBJECTIVE: The aim of this study is to evaluate factors correlated to SBL (anthropometric and radiologic) and to establish a preoperative SBL prediction. MATERIAL AND METHODS: In this single-center prospective study, 30 adult patients who underwent laparotomy with a preoperative CT scan were included. Intraoperative SBL measurement was performed with an umbilical tape. Anthropometric parameters were age, gender, height, and BMI. 2D radiological measurements consisted of subcutaneous thickness, abdominal diameters, waist circumference, and mesenteric root length. 3D radiological volumetric reconstructions consisted of whole small bowel and mesentery (WSBM), lean small bowel and mesentery (LSBM), and fat small bowel and mesentery (FSBM). RESULTS: Mean intraoperative measurement of SBL was 531 ± 105 cm. Among the clinical and radiological measurements, the FSBM volume presented the greatest dispersion. Height (p < 0.02) and LSBM volume (p < 0.01) were significantly correlated to the SBL in univariate analysis. LSBM volume was the only measurement significantly associated with SBL in multivariate analysis (p < 0.006). From the multivariate model, a formula was created to predict SBL. The mean percentage difference between predicted and intraoperative SBL measurements for all patients was 13.7%, and 8.4% for obese patients. CONCLUSION: LSBM volume is significantly correlated to the SBL. A preoperative SBL prediction with low percentage error could be performed with LSBM volume.