Management of abdominal emergencies in adults using telemedicine and artificial intelligence.

The terms "telemedicine" and "artificial intelligence" (AI) are used today throughout all fields of medicine, with varying degrees of relevance. If telemedicine corresponds to practices currently being developed to supply a high quality response to medical provider shortages in the general provision of healthcare and to specific regional challenges. Through the possibilities of "scalability" and the "augmented physician" that it has helped to create, AI may also constitute a revolution in our practices. In the management of surgical emergencies, abdominal pain is one of the most frequent complaints of patients who present for emergency consultation, and up to 20% of patients prove to have an organic lesion that will require surgical management. In view of the very large number of patients concerned, the variety of clinical presentations, the potential seriousness of the etiological pathology that sometimes involves a life-threatening prognosis, healthcare workers responsible for these patients have logically been led to regularly rely on imaging examinations, which remain the critical key to subsequent management. Therefore, it is not surprising that articles have been published in recent years concerning the potential contributions of telemedicine (and teleradiology) to the diagnostic management of these patients, and also concerning the contribution of AI (albeit still in its infancy) to aid in diagnosis and treatment, including surgery. This review article presents the existing data and proposes a collaborative vision of an optimized patient pathway, giving medical meaning to the use of these tools.

Whole-body MRI with diffusion-weighted sequences compared with 18 FDG PET-CT, CT and superficial lymph node ultrasonography in the staging of advanced cutaneous melanoma: a prospective study.

OBJECTIVES: The aim of our study was to compare the diagnostic performances of non-radiating whole-body magnetic resonance imaging (wbMRI), either volumetric, with Volumetric interpolated breath-hold examination (VIBE) or metabolic, with diffusion-weighted sequences (wbMRI), with classical irradiating techniques such as PET-CT, CT and with lymph node ultrasonography (US) for the staging of advanced melanoma. PATIENTS AND METHODS: Thirty-seven melanoma AJCC stage IV patients were prospectively included. All images were independently interpreted without prior knowledge of the results of studies performed with concurrent techniques, and all imaging techniques were scheduled within a mean interval of 7 days. The overall and site-specific diagnosis performances of each imaging modality were studied, as well as the interest of combined MRI VIBE and diffusion sequences. RESULTS: The number of visceral or lymph node metastases spotted was, respectively, 218, with 125 metastases for wbMRI, 191/103 for PET-CT, 209/115 for CT and 33/13 for lymph node US. No statistically significant difference (P < 0.05) of overall diagnostic performances between wbMRI (Se 84%, Sp 87.1%, PPV 89.8%, NPV 80.2%) and PET-CT (Se 79.8%, Sp 93.1%, PPV 93.2%, NPV 79.4%) was observed. No statistically significant difference was found between wbMRI and PET-CT with two channels for CT with respect to different metastatic sites. Compared with the CT, wbMRI had significantly better overall specificity (P = 0.0011) and PPV (P = 0.02). For lung exploration, sensitivity of wbMRI (51.6%) was inferior to CT (71.4%). To detect superficial metastatic lymph nodes, wbMRI and US both showed high diagnostic accuracy with no statistically significant difference. Intra-observer agreement was almost perfect for all imaging modalities considering the overall staging. Inter-observer agreement for wbMRI and diffusion alone was almost perfect except for bone and lymphatic sites. Overall diagnostic performance of diffusion alone was significantly inferior to those of combined VIBE and diffusion sequences. CONCLUSIONS: Whole-body MRI, using diffusion weighted sequences, was a reliable non-radiating imaging for staging of melanoma and offers the same diagnostic performances than combined CT, PET-CT and lymph node US.

[Diagnosis of cardiac amyloidosis using magnetic resonance imaging: a new reliable, non-invasive technique to be validated]. / Diagnostic de l'amylose cardiaque par imagerie par résonnance magnétique nucléaire : une nouvelle méthode fiable, non invasive, en cours de validation.

INTRODUCTION: Amyloidosis is characterised by extracellular tissue deposition of insoluble fibrillar protein in various organs. Cardiac involvement is associated with the worse prognosis and the main cause of death. It needs a prompt diagnosis, which could be sometimes difficult to obtain. Endomyocardial biopsy remains the gold standard diagnostic technique, but recent studies on cardiac magnetic resonance imaging (MRI) indicate that this imaging procedure may be useful to the diagnosis of amyloidosis. CASE REPORTS: We report three patients with systemic amyloidosis who underwent cardiac MRI for the diagnosis or the follow-up of their disease. In addition to poorly specific signs of restrictive cardiomyopathy, cardiac MRI showed, after gadolinium enhancement that was considered characteristic of amyloidosis. CONCLUSION: Cardiac MRI is a useful diagnostic tool in cardiac amyloidosis, as it was shown in recent studies. Compared to endomyocardial biopsy it is a non-invasive technique that is now more readily accessible and that seems to have an acceptable specificity.

Downregulation of remodelling enzymatic activity induced by an angiotensin-converting enzyme inhibitor (perindopril) reduces the degeneration of experimental abdominal aortic aneurysms in a rat model.

AIMS: Angiotensin-converting enzyme (ACE) inhibitors have proven their ability to affect vascular wall remodelling, in addition to their anti-hypertensive effects. The aim of this study was to assess the impact of perindopril on the development of abdominal aortic aneurysm (AAA) in a rat model, and its correlation to enzyme activities involved in vascular wall remodelling. METHODS: The model of the decellularised aortic xenograft in Lewis rat was chosen. Rats were randomised to two groups: group P fed with 3 mg kg(-1) of perindopril daily during 30 days, or control group C (n = 15 per group)). Rats were euthanised at 30 days for analysis. AAA growth and histological changes in the aortic wall were measured by histomorphometry. Proteolytic activities were measured by gelatin zymography of conditioned medium for activematrix metalloproteinase 9/pro-matrix metalloproteinase 9 (MMP9/pro-MMP9) and activeMMP2/pro-MMP2, and by quantitative immunofluorescence tissue for elastase and plasmin. RESULTS: The mean maximal diameter of AAAs at 30 days was significantly lower in the treated group P compared with the control group C (2.5 ± 1.0 vs. 4.9 ± 2.1 mm; P < 0.01). The expansion rate of AAAs after 30 days was significantly reduced in group P compared with group C (36 ± 14% vs. 67 ± 23%; P < 0.01). Pro-MMP9 and MMP9 activities were significantly decreased in relative intensity (RI) in group P compared with group C (0.43 ± 0.64 RI vs. 1.02 ± 0.61 RI, P = 0.01; 0.18 ± 0.57 RI vs. 0.66 ± 1.19 RI, P = 0.004). The activation rate of MMP2 was also significantly lower in group P compared with group C (1.27 ± 0.42 vs. 1.67 ± 0.44; P = 0.002). Elastase and plasmin tissue activities were significantly lower in group P compared with group C, respectively (3.9 ± 3.3 vs. 5.8 ± 3.7 IF min(-1) g(-1),and 25.9 ± 23.9 vs. 49.1 ± 38.7 IF min(-1) g(-1); P < 0.05). CONCLUSION: After 30 days of treatment by perindopril, a significant decrease in aneurysmal degeneration of the decellularised aortic xenograft AAA model was observed. This phenomenon appears to be induced by a downregulation of enzymes involved in the aortic wall remodelling during aneurysmal degeneration.