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Early Detection of Underlying Cavernomas in Patients with Spontaneous Acute Intracerebral Hematomas.AJNR. American Journal of Neuroradiology Jul 2023Early identification of the etiology of spontaneous acute intracerebral hemorrhage is essential for appropriate management. This study aimed to develop an imaging model...
BACKGROUND AND PURPOSE
Early identification of the etiology of spontaneous acute intracerebral hemorrhage is essential for appropriate management. This study aimed to develop an imaging model to identify cavernoma-related hematomas.
MATERIALS AND METHODS
Patients 1-55 years of age with acute (≤7 days) spontaneous intracerebral hemorrhage were included. Two neuroradiologists reviewed CT and MR imaging data and assessed the characteristics of hematomas, including their shape (spherical/ovoid or not), their regular or irregular margins, and associated abnormalities including extralesional hemorrhage and peripheral rim enhancement. Imaging findings were correlated with etiology. The study population was randomly split to provide a training sample (50%) and a validation sample (50%). From the training sample, univariate and multivariate logistic regression was performed to identify factors predictive of cavernomas, and a decision tree was built. Its performance was assessed using the validation sample.
RESULTS
Four hundred seventy-eight patients were included, of whom 85 had hemorrhagic cavernomas. In multivariate analysis, cavernoma-related hematomas were associated with spherical/ovoid shape (< .001), regular margins ( = .009), absence of extralesional hemorrhage ( = .01), and absence of peripheral rim enhancement ( = .002). These criteria were included in the decision tree model. The validation sample ( = 239) had the following performance: diagnostic accuracy of 96.1% (95% CI, 92.2%-98.4%), sensitivity of 97.95% (95% CI, 95.8%-98.9%), specificity of 89.5% (95% CI, 75.2%-97.0%), positive predictive value of 97.7% (95% CI, 94.3%-99.1%), and negative predictive value of 94.4% (95% CI, 81.0%-98.5%).
CONCLUSIONS
An imaging model including ovoid/spherical shape, regular margins, absence of extralesional hemorrhage, and absence of peripheral rim enhancement accurately identifies cavernoma-related acute spontaneous cerebral hematomas in young patients.
Topics: Humans; Cerebral Hemorrhage; Early Diagnosis; Hematoma; Magnetic Resonance Imaging; Predictive Value of Tests; Infant; Child, Preschool; Child; Adolescent; Young Adult; Adult; Middle Aged
PubMed: 37385679
DOI: 10.3174/ajnr.A7914 -
Neurology India 2022Malignant atrophic papulosis (MAP), or systemic Degos disease, is an obliterative vasculopathy of unknown origin, characterized by erythematous papules found on the... (Review)
Review
Malignant atrophic papulosis (MAP), or systemic Degos disease, is an obliterative vasculopathy of unknown origin, characterized by erythematous papules found on the skin, central nervous system (Neuro-MAP) and gastrointestinal tract. Neurological involvement occurs in approximately 20% of systemic cases, is progressive and largely fatal. It can be described in two forms: 1) the parenchymal presenting with meningoencephalitis and meningomyelitis and 2) the neurovascular presenting with large cerebral infarcts, intracranial and subarachnoid hemorrhage, subdural hematoma and venous sinus thrombosis. Predilection to subdural hematoma or hygroma is characteristic for neurological involvement in MAP in comparison to other vasculpathies and vasculitides. Peripheral nervous system manifestations are less common and include polyradiculopathy, neuropathy, and myopathy. CSF analysis usually shows mild to moderate pleocytosis, increased protein content, and normal glucose. Brain MRI may reveal cortical, subcortical and deep white matter ischemic lesions with possible nodular, leptomeningeal, dural, or ependymal enhancement. Spinal cord MRI may reveal patchy lesions from the periphery to the center or cord atrophy in progressive course. Neurological involvement in MAP has a grave prognosis. The interval from onset of papulosis to death averages two years in patients with neurological involvement. There is no confirmed treatment for MAP but there are promising reports with eculizumab and treprostinil.
Topics: Atrophy; Hematoma, Subdural; Humans; Malignant Atrophic Papulosis; Prognosis; Skin
PubMed: 35263846
DOI: 10.4103/0028-3886.338719 -
Anatomia, Histologia, Embryologia Jan 2019Fish are the most diverse species of all vertebrate groups, and their blood cells have shown variable characteristics in terms of morphology. Cytochemical staining for...
Fish are the most diverse species of all vertebrate groups, and their blood cells have shown variable characteristics in terms of morphology. Cytochemical staining for enzyme activity in blood leukocytes will help assess the immune function of fish. We characterize blood cells from crucian carp (Carassius auratus) and grass carp (Ctenopharyngodon idellus) by using a Diff-Quick stain as well as different cytochemical methods. Blood specimens obtained from crucian carp and grass carp were evaluated after cytochemical staining for acid phosphatase (ACP), alkaline phosphatase (ALP), naphthol AS chloroacetate esterase (AS-DNCE), naphthyl acetate esterase (NAE), α-naphthyl butyrate esterase (NBE), peroxidase (MPO) and periodic acid-Schiff's reaction (PAS) using commercial kits. Blood cell types were evaluated based on their morphological characteristics and the presence or absence of specific chromogen. The expression pattern of enzymes was similar between the two Cyprinidae and was also broadly consistent with other fish species. However, there were some interesting differences detected between crucian carp and grass carp, including naphthol AS chloroacetate esterase activity in monocytes, peroxidase activity and location in thrombocytes. The ACP, ALP and MPO expressions of different leukocytes of the two Cyprinidae were evaluated by Image Pro Plus and were analysed for statistical significant differences. This investigation provides basic haematology and enzyme activity analyses for crucian carp and grass carp and serves as an approach to evaluating the immune response of fish.
Topics: Acid Phosphatase; Alkaline Phosphatase; Animals; Blood Cells; Carboxylic Ester Hydrolases; Carps; Gene Expression Regulation; Goldfish; Hematology; Histocytochemistry; Naphthol AS D Esterase; Periodic Acid-Schiff Reaction; Peroxidase; Staining and Labeling
PubMed: 30353570
DOI: 10.1111/ahe.12407 -
Journal of Special Operations Medicine... 2021Administration of fresh whole blood (FWB) is a life-saving treatment that prolongs life until definitive surgical intervention can be performed; however, collecting FWB...
BACKGROUND
Administration of fresh whole blood (FWB) is a life-saving treatment that prolongs life until definitive surgical intervention can be performed; however, collecting FWB is a time-consuming and resource-intensive process. Furthermore, it may be difficult to collect sufficient FWB to treat critically wounded patients or multiple-hemorrhaging casualties. This study describes the effect of airdrop on FWB and explores the possibility of using airdrop to deliver FWB to combat medics treating casualties in the prehospital setting when FDA-approved, cold-stored blood products are not readily available and timely casualty evacuation (CASEVAC) is not feasible.
METHODS
Four units of FWB were collected from volunteer donors and loaded into a blood cooler that was dropped from a fixed-wing aircraft under a standard airdrop training bundle (SATB) parachute. A control group of 4 units of FWB was stored in a blood cooler that was not dropped. Baseline and postintervention laboratory samples were measured in both airdropped and control units, including full blood counts, prothrombin time/partial thromboplastin time/international normalized ratio (PT/PTT/INR), pH, lactate, potassium, indirect bilirubin, glucose, fibrinogen, lactate dehydrogenase, and peripheral blood smears.
RESULTS
The blood cooler, cooling bags, and all 4 FWB units did not sustain any damage from the airdrop. There was no evidence of hemolysis. All airdropped blood met parameters for transfusion per the Whole Blood Transfusion Clinical Practice Guideline of the Joint Trauma System (JTS).
CONCLUSIONS
Airdrop of FWB in a blood cooler with a SATB parachute may be a viable way of delivering blood products to combat medics treating hemorrhaging patients in the prehospital setting, although further research is needed to fully validate the safety of this method of FWB delivery.
Topics: Blood Transfusion; Hemorrhage; Humans; Rain
PubMed: 34105118
DOI: 10.55460/6Q4Y-H71J -
Translational Stroke Research Apr 2019Spontaneous intracerebral hemorrhage (ICH) accounts for approximately 10 to 30% of all acute cerebrovascular events, and it is the type of stroke associated with the... (Review)
Review
Spontaneous intracerebral hemorrhage (ICH) accounts for approximately 10 to 30% of all acute cerebrovascular events, and it is the type of stroke associated with the highest rates of mortality and residual disability. The inflammatory response is early triggered by hematoma components and can enhance the damage within the hemorrhagic brain. Assessment of peripheral biomarkers of inflammation could contribute to increase knowledge about some of the mechanisms involved in the ICH-induced injury and yield information on the disease course. The neutrophil-to-lymphocyte ratio (NLR) integrates information on both the innate and adaptive compartments of the immunity and represents a reliable measure of the inflammatory burden. The aim of the current review is to highlight the available evidence about the relationships between the NLR and clinical outcome in patients with acute ICH and provide critical insights into the underlying pathophysiology. Since no therapy targeting ICH-induced primary injury has yielded conclusive benefits and ICH treatment remains mainly supportive within a framework of general critical care management, these findings could also contribute to identify new potential targets for neuroprotection and develop novel therapeutic strategies.
Topics: Acute Disease; Animals; Cerebral Hemorrhage; Humans; Lymphocytes; Neutrophils
PubMed: 30090954
DOI: 10.1007/s12975-018-0649-4 -
Blood Coagulation & Fibrinolysis : An... Jun 2023People with hemophilia tend to develop joint lesions secondary to the recurrent hemarthroses typical of their condition. These usually include chronic synovitis and...
People with hemophilia tend to develop joint lesions secondary to the recurrent hemarthroses typical of their condition. These usually include chronic synovitis and arthropathy chiefly affecting their ankles, knees, and elbows. In addition, muscular hematomas, albeit less frequently, may also result in complications such as acute compartment syndrome, pseudotumors, bone cysts and peripheral nerve compression. Joint lesions may require some of the following surgical interventions: arthroscopic synovectomy (in cases of synovitis), arthroscopic joint debridement, radial head resection, opening-wedge tibial osteotomy, arthrodesis, arthrodiastasis (of the ankle), tendon lengthening (hamstrings, Achilles tendon), progressive extension of the knee by placing an external fixator in cases of flexion contracture of the knee, supracondylar femoral extension osteotomy in cases of knee flexion contracture and, eventually, a total joint arthroplasty when the affected joint has been destroyed and the patient experiences severe joint pain. Total knee arthroplasty in hemophilic patients is associated with a high infection risk (7% on average). As regards the complications following muscle hematomas, acute compartment syndrome requires urgent performance of a fasciotomy when hematological treatment is incapable of resolving the problem. Surgical resection of hemophilic pseudotumors is the best solution, with those affecting the pelvis (secondary to iliopsoas hematomas) being particularly difficult to resolve. Peripheral nerve lesions can often be effectively addressed with hematological treatment, although a surgical neurolysis of the ulnar nerve is indicated if nonoperative treatment fails.
Topics: Humans; Hemophilia A; Orthopedic Procedures; Hemarthrosis; Synovitis; Arthroplasty, Replacement, Knee; Contracture; Hematoma; Compartment Syndromes
PubMed: 37254722
DOI: 10.1097/MBC.0000000000001203 -
Hand Clinics Nov 2018A spastic limb refers to one with increased tone. This commonly results from an upper motor neuron injury, which, in turn, leads to disinhibition of reflex arcs. At the... (Review)
Review
A spastic limb refers to one with increased tone. This commonly results from an upper motor neuron injury, which, in turn, leads to disinhibition of reflex arcs. At the level of the elbow, affected individuals typically exhibit a flexion posture secondary to spastic contracture of the biceps, brachialis, and brachioradialis muscles. Surgical treatment aims to improve access for hygiene, function, and cosmetic appearance of the affected limb. The specific surgical intervention performed depends on the degree of elbow flexion contracture and whether there is an associated joint contracture or soft tissue deficit.
Topics: Contraindications, Procedure; Elbow Joint; Hematoma; Humans; Intraoperative Complications; Muscle Spasticity; Muscle Strength; Peripheral Nerve Injuries; Postoperative Care; Postoperative Complications; Preoperative Care; Supination; Surgical Flaps; Tendon Transfer; Vascular System Injuries
PubMed: 30286964
DOI: 10.1016/j.hcl.2018.06.007 -
Expert Review of Hematology Nov 2021Drug repositioning (DR) is defined as determining new therapeutic applications for existing drugs. This approach is advantageous over drug discovery in accelerating...
INTRODUCTION
Drug repositioning (DR) is defined as determining new therapeutic applications for existing drugs. This approach is advantageous over drug discovery in accelerating clinical development, in terms of lower costs, a shortened development period, a well-known action mechanism, a feasible dosage, and an acceptable safety profile.
AREAS COVERED
This work was aimed at reviewing agents with successful DR in hematology.
EXPERT OPINION
Thalidomide and plerixafor have been successfully repositioned for treating multiple myeloma and harvesting peripheral blood stem cells, respectively. The former was originally developed as a sedative and the latter as an anti-HIV drug. Currently, the feasibility of repositioning various agents is being explored (e.g. an anti-influenza virus drug oseltamivir for primary immune thrombocytopenia, an anti-HIV drug abacavir for adult T-cell leukemia, and a macrolide antibiotic clarithromycin for multiple myeloma). Furthermore, bosutinib for chronic myeloid leukemia or the antiplatelet drug cilostazol have been suggested to have clinical benefits for the management of amyotrophic lateral sclerosis and ischemic stroke, respectively. To promote DR, effective application of artificial intelligence or stem cell models, comprehensive database construction shared between academia and pharmaceutical companies, suitable handling of drug patents, and wide cooperation in the area of specialty are warranted.
Topics: Artificial Intelligence; Drug Repositioning; Hematology; Hematopoietic Stem Cell Mobilization; Heterocyclic Compounds; Humans
PubMed: 34657533
DOI: 10.1080/17474086.2021.1995348 -
IEEE Reviews in Biomedical Engineering 2021Segmentation of white blood cells in digital haematology microscope images represents one of the major tools in the diagnosis and evaluation of blood disorders.... (Review)
Review
Segmentation of white blood cells in digital haematology microscope images represents one of the major tools in the diagnosis and evaluation of blood disorders. Pathological examinations are being the gold standard in many haematology and histophathology, and also play a key role in the diagnosis of diseases. In clinical diagnosis, white blood cells are analysed by pathologists from peripheral blood smears samples of patients. This analysis is mainly based on morphological features and characteristics of the white blood cells and their nuclei and cytoplasm, including, shapes, sizes, colours, textures, maturity stages and staining processes. Recently, Computer Aided Diagnosis techniques have been rapidly growing in the digital haematology area related to white blood cells, and their nuclei and cytoplasm detection, as well as their segmentation and classification techniques. In digital haematology image analysis, these techniques have played and will continue to play, a vital role for providing traceable clinical information, consolidating pertinent second opinions, and minimizing human intervention. This study outlines, discusses, and introduces the major trends from a particular review of detection and segmentation methods for white blood cells and their nuclei and cytoplasm from digital haematology microscope images. Performance of existing methods have been comprehensively compared, taking into account databases used, number of images and limitations. This study can also help us to identify the challenges that remain, in achieving a robust analysis of white blood cell microscope images, which could support the diagnosis of blood disorders and assist researchers and pathologists in the future. The impact of this work is to enhance the accuracy of pathologists' decisions and their efficiency, and overall benefit the patients for faster and more accurate diagnosis. The significant of the paper on intelligent system is that provides future potential techniques for solving overlapping white blood cell identification and other problems microscopic images. The accurate segmentation and detection of white blood cells can increase the accuracy of cell counting system for diagnosing diseases in the future.
Topics: Algorithms; Cell Nucleus; Cytoplasm; Hematology; Humans; Image Processing, Computer-Assisted; Leukocytes; Microscopy; Support Vector Machine
PubMed: 32746365
DOI: 10.1109/RBME.2020.3004639 -
Clinical Neuroradiology Jun 2019The imaging appearance of neoplastic hematoma can be complicated by the presence of a large hematoma, even on magnetic resonance imaging (MRI). We describe the role of...
BACKGROUND
The imaging appearance of neoplastic hematoma can be complicated by the presence of a large hematoma, even on magnetic resonance imaging (MRI). We describe the role of MR perfusion (MRP) in detecting neoplastic hematomas in patients with intraparenchymal hematoma (IPH).
MATERIAL AND METHODS
A retrospective review was performed for consecutive patients with IPH, where MRP was performed. Routine, post-gadolinium MRI and MRP were analyzed. All patients were either operated on for evacuation of IPH or followed up on imaging. The MRP parameters of cerebral blood volume (CBV) and cerebral blood flow (CBF) and pattern of enhancement (peripheral linear vs. nodular) were recorded. Sensitivity, specificity, positive (PPV) and negative predictive values (NPV) were calculated for these parameters for diagnosing neoplastic hematoma.
RESULTS
Of 116 patients with MRP, 16 patients (male 8; mean age-65.5 years) had IPH on their initial MRI. For diagnosing neoplastic hematoma, the sensitivity, specificity, PPV and NPV for increased CBF and CBV were 100%, 88.9%, 87.5%, and 100%; for peripheral linear enhancement were 100%, 28.6%, 50%, 100% and for nodular enhancement were 85.7%, 77.8%, 75% and 12.5%, respectively. The combination of peripheral linear enhancement and increased CBF and CBV showed 100% sensitivity, specificity, PPV and NPV.
CONCLUSION
In our small series, the combination of peripheral linear enhancement and increased CBF and CBV showed 100% sensitivity, specificity, PPV and NPV for diagnosing a neoplastic hematoma. These findings need to be validated in a larger study.
Topics: Aged; Aged, 80 and over; Brain Neoplasms; Cerebral Hemorrhage; Female; Frontal Lobe; Hematoma; Humans; Magnetic Resonance Angiography; Magnetic Resonance Imaging; Male; Middle Aged; Retrospective Studies; Sensitivity and Specificity; Tomography, X-Ray Computed
PubMed: 29417155
DOI: 10.1007/s00062-018-0664-6