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World Journal of Clinical Cases May 2024In the context of mediastinal emphysema/pneumomediastinum, the main aetiologies are associated with oesophageal perforation, lung pathology or post head and neck surgery...
In the context of mediastinal emphysema/pneumomediastinum, the main aetiologies are associated with oesophageal perforation, lung pathology or post head and neck surgery related. The main way to differentiate the pathologies would be through Computed Tomographic Imaging of the Thorax and abdomen with oral and intravenous contrast in the context of triple phase imaging. The causes of pneumomediastinum should be differentiated between traumatic and non-traumatic. Oesophageal perforation (Boerhaave syndrome) is associated with Mackler's triad in upto 50% of patients (severe retrosternal chest pain, pneumomediastinum, mediastinitis). Whereas in cases of lung pathology this can be associated with pneumothorax and pleural effusion.
PubMed: 38817226
DOI: 10.12998/wjcc.v12.i15.2479 -
International Journal of Surgery Case... Apr 2024Perineal impalements, although rare, exhibit high morbidity and mortality, associated with penetrating traumas by long objects, often resulting from falls or assaults....
INTRODUCTION
Perineal impalements, although rare, exhibit high morbidity and mortality, associated with penetrating traumas by long objects, often resulting from falls or assaults. The risk of pelvic bleeding and the need for immediate intervention to preserve vital organs are characteristics of these injuries, whose severity demands a multidisciplinary approach.
CASE DESCRIPTION
A 57-year-old male patient, a victim of a 5-meter fall, suffered an extensive perineal impalement. With stable vital signs, he underwent the ATLS protocol, followed by whole-body computed tomography (WBCT), revealing a metallic object traversing the perineum, abdomen, and thorax. The surgery involved laparotomy, sternotomy, and removal of the object under direct visualization, with repair of prostatic, vesical, hepatic, and diaphragmatic injuries. The postoperative period included transfusions and urological follow-up.
DISCUSSION
Perineal impalements require immediate attention, and their approach is influenced by clinical factors and the extent of the object. The importance of preoperative evaluation with tomography, removal of the object under direct visualization, and comprehensive surgical management is highlighted. The decision for conservative treatment is reserved for less severe cases. This work has been reported in line with the SCARE criteria.
CONCLUSION
Perineal impalements demand a rapid and integrated approach to optimize survival. Object removal, often performed by exploratory laparotomy, stands out as an essential procedure. Multidisciplinary expertise is crucial for the effective management of these complex injuries.
METHODS
This work has been reported in line with the SCARE criteria.
PubMed: 38815442
DOI: 10.1016/j.ijscr.2024.109652 -
Turkish Journal of Medical Sciences 2023To evaluate and compare magnetic resonance imaging (MRI) sequences that could potentially be used in the diagnosis of coronavirus disease 2019 (COVID-19). (Comparative Study)
Comparative Study
BACKGROUND AND AIM
To evaluate and compare magnetic resonance imaging (MRI) sequences that could potentially be used in the diagnosis of coronavirus disease 2019 (COVID-19).
MATERIALS AND METHODS
Included in the study were 42 patient who underwent thorax computed tomography (CT) for COVID-19 pneumonia and thorax MRI for any reason within 24 h after CT. The T2-weighted fast spin echo periodically rotated overlapping parallel lines with enhanced reconstruction (PROPELLER) (T2W-FSE-P), fast imaging employing steady-state acquisition, T2 fat-saturated FSE, axial T1 liver acquisition with volume acceleration (LAVA) and single-shot FSE images were compared in terms of their ability to show COVID-19 findings.
RESULTS
The mean age of the patients was 47.2 ± 24 years. Of the patients, 22 were male (52.4%) and 20 (47.6%) were female. The interobserver intraclass coefficient (ICC) for the image quality score was the highest in the T2W-FSE-P sequence and lowest in the T1 LAVA sequence. All of the lesion-based evaluations of the interobserver agreement were statistically significant, with the kappa value varying between 0.798 and 0.998.
CONCLUSION
All 5 sequences evaluated in the study were successful in showing the parenchymal findings of COVID-19. Since the T2W-FSE-P sequence had the best scores in both interobserver agreement and ICC for the image quality score, it was considered that it can be included in thorax MRI examinations to assist the diagnosis of COVID-19.
Topics: Humans; COVID-19; Male; Female; Middle Aged; Magnetic Resonance Imaging; Adult; SARS-CoV-2; Thorax; Tomography, X-Ray Computed; Aged; Lung
PubMed: 38813029
DOI: 10.55730/1300-0144.5687 -
Radiology Case Reports Aug 2024Inferior phrenic artery to pulmonary artery fistulae are a rare anomaly seen on CT thorax angiogram when evaluating for certain pulmonary pathological conditions. A...
Inferior phrenic artery to pulmonary artery fistulae are a rare anomaly seen on CT thorax angiogram when evaluating for certain pulmonary pathological conditions. A 79-year-old man with hemothorax on chest X-ray was evaluated by interventional radiology for embolization of a bleeding vessel. During the procedure, a fistulous connection between the right inferior phrenic artery and right pulmonary artery with signs of extravasation was found and embolized, significantly reducing the size of the hemothorax. This case demonstrates that inferior phrenic artery to pulmonary artery fistulae, a rarely seen vascular anomaly, can result in life-threatening hemothorax.
PubMed: 38812593
DOI: 10.1016/j.radcr.2024.04.086 -
World Journal of Clinical Cases May 2024Thymic carcinoid (TC) is a rare entity among anterior mediastinal malignancies. TCs are neuroendocrine carcinomas that constitute approximately 2%-5% of all thymic...
BACKGROUND
Thymic carcinoid (TC) is a rare entity among anterior mediastinal malignancies. TCs are neuroendocrine carcinomas that constitute approximately 2%-5% of all thymic epithelial tumors.
CASE SUMMARY
The study reported a rare TC with multiple bone metastases. A 77-year-old man presented with a 2-month history of lower back pain and weight loss of 5 kg. Magnetic resonance imaging scans revealed damage to the lumbar spine, sacrocaudal vertebrae and iliac crest, suggesting bone metastasis; computed tomography (CT) scan of the thorax showed a calcified anterior mediastinal mass; positron emission tomography-CT demonstrated multiple abnormal bone signals; and laboratory work-up showed no endocrine abnormalities. Fine-needle aspiration biopsy revealed predominantly single small, round to oval cells with scant cytoplasm and some loose clusters, suggesting endocrine manifestations. The pathological diagnosis was atypical carcinoid, which tend to originate from the thymus and was classified as intermediate-highly invasive. The patient underwent anlotinib-targeted therapy. Anlotinib (12 mg) was administered daily for 2 wk, after which the patient was allowed to rest for 21 d. Follow-up CT after one year demonstrated that the tumor had shrunk by approximately 29% after therapy. Treatment has a long stable disease benefit of more than 2.5 years.
CONCLUSION
These findings demonstrated that anlotinib is a promising treatment regimen for patients with TC and multiple bone metastases.
PubMed: 38808334
DOI: 10.12998/wjcc.v12.i13.2275 -
Open Veterinary Journal Apr 2024Perforating foreign bodies from the gastrointestinal tract, such as wooden skewers, are reported in the small animal literature producing inflammatory/infectious lesions...
BACKGROUND
Perforating foreign bodies from the gastrointestinal tract, such as wooden skewers, are reported in the small animal literature producing inflammatory/infectious lesions in the thorax, abdomen, and musculoskeletal system, which can be life-threatening in some instances. Several imaging modalities have been used, and advanced imaging techniques have shown a great advantage in its diagnosis and pre-surgical planning.
AIM
The objective of this study is to describe the computed tomographic findings in a group of seven medium to large breed dogs with perforating wooden skewers and foreign bodies migrated from the gastrointestinal tract.
METHODS
The medical records database was searched for dogs with a suspected diagnosis of a perforating wooden foreign body migrated from the gastrointestinal tract in which a computed tomographic study was performed. Signalment, history, and clinicopathological findings (when available) were retrieved, and the computed tomographic studies were reviewed.
RESULTS
Clinical signs vary depending on the anatomical regions affected through the perforating pathway. All foreign bodies were identified and showed a median attenuation of 79 HU, with the most common localization being the stomach followed by the jejunum. Peritoneal fat stranding surrounding the perforation site was the most frequent computed tomographic finding. The presence of peritoneal free fluid and/or gas was uncommon. Pleural effusion, pulmonary perforation, and pneumothorax were present in most of the cases with the foreign body traversing the pleural space. Pulmonary cavitary lesions were always reported when the ending tip of the wooden skewer was within the pulmonary parenchyma. Soft tissue abscessation was recognized in all cases where the ending tip was lodged in muscular or subcutaneous tissues.
CONCLUSION
Findings supported the variability of the secondary lesions caused by this type of foreign body and the utility of computed tomography in their recognition, as well as in the identification of the wooden skewer.
Topics: Animals; Dogs; Tomography, X-Ray Computed; Foreign Bodies; Male; Gastrointestinal Tract; Female; Dog Diseases; Retrospective Studies
PubMed: 38808289
DOI: 10.5455/OVJ.2024.v14.i4.7 -
Sisli Etfal Hastanesi Tip Bulteni 2024Numerous neurological manifestations associated with COVID-19 have been reported. However, abducens nerve palsy (ANP) associated with COVID-19 is very rare and mostly...
Numerous neurological manifestations associated with COVID-19 have been reported. However, abducens nerve palsy (ANP) associated with COVID-19 is very rare and mostly related to accompanying respiratory symptoms. Here we present a 29-year-old woman with unilateral ANP manifesting with diplopia and positive SARS-CoV-2 S antibodies, which were checked later. On admission, she had signs of viral pneumonia in thorax CT without any respiratory symptoms. Her cranial neuroimaging revealed no abnormality. Following treatment with favipiravir 2x1600 mg loading dose and then 2x600mg daily maintenance, dexamethasone 8 mg/day and enoxaparin 6000 IU/day, her CT findings recovered completely whereas her ANP only partially resolved. One week after the end of COVID-19 treatment, she also developed Herpes simplex keratitis which was successfully treated with valacyclovir. It should be kept in mind that isolated abducens nerve palsy may be the only finding of COVID-19 cases without any respiratory symptoms.
PubMed: 38808042
DOI: 10.14744/SEMB.2023.55491 -
Journal of Insect Science (Online) May 2024Honey bees use grooming to defend against the devastating parasite Varroa destructor Anderson and Trueman. We observed the grooming responses of individual bees from...
Honey bees use grooming to defend against the devastating parasite Varroa destructor Anderson and Trueman. We observed the grooming responses of individual bees from colonies previously chosen for high- and low-grooming behavior using a combination of mite mortality and mite damage. Our aim was to gain insight into specific aspects of grooming behavior to compare if high-grooming bees could discriminate between a standardized stimulus (chalk dust) and a stimulus of live Varroa mites and if bees from high-grooming colonies had greater sensitivity across different body regions than bees from low-grooming colonies. We hypothesized that individuals from high-grooming colonies would be more sensitive to both stimuli than bees from low-grooming colonies across different body regions and that bees would have a greater response to Varroa than a standardized irritant (chalk dust). Individuals from high-grooming colonies responded with longer bouts of intense grooming when either stimulus was applied to the head or thorax, compared to sham-stimulated controls, while bees from low-grooming colonies showed no differences between stimulated and sham-stimulated bees. Further, high-grooming bees from colonies with high mite damage exhibited greater grooming to Varroa than high-grooming colonies with only moderate mite damage rates. This study provides new insights into Varroa-specific aspects of grooming, showing that although a standardized stimulus (chalk dust) may be used to assess general grooming ability in individual bee grooming assays, it does not capture the same range of responses as a stimulus of Varroa. Thus, continuing to use Varroa mites in grooming assays should help select colonies with more precise sensitivity to Varroa.
Topics: Animals; Bees; Grooming; Varroidae
PubMed: 38805645
DOI: 10.1093/jisesa/ieae057 -
Radiology Case Reports Aug 2024Scurvy is an infrequent pathological condition resulting from a sustained dietary vitamin C deficiency. Radiology becomes pivotal because the diagnostic process for...
Scurvy is an infrequent pathological condition resulting from a sustained dietary vitamin C deficiency. Radiology becomes pivotal because the diagnostic process for scurvy can be intricate, given its resemblance to bone neoplasms. A 6-year-old boy, reported persistent pain and swelling in the right thigh for 2 months prior to hospitalization. Clinical examination revealed a mass localized in the right thigh and anemia. A radiograph of the right femur demonstrated extensive osteopenic changes, "Trümmerfeld zone", "Frankel line", "Pelkin fracture", "Wimberger ring sign", and para-epiphyseal subperiosteal hematoma. The absence of any such cases in our institution over the preceding decade emphasizes the uniqueness of this presentation. Histopathological evaluation yielded atypical results, prompting further radiographic assessment of the left femur and thorax. The subsequent findings corroborated the classic "scorbutic rosary" presentation, indicative of scurvy. The patient's symptoms gradually resolved with high-dose supplementation of vitamin C. Scurvy predominantly presents with musculoskeletal manifestations. Plasma vitamin C level assessment is the gold standard for the diagnosis, but it is currently inaccessible in our nation. Consequently, radiographic evaluation reveals pathognomonic features of the disorder. In thoracic radiographs, the "scorbutic rosary" presentation is evident. In contrast, long bones exhibit hallmarks of scurvy: diffuse osteopenia, "Frankel line", "Trümmerfeld zone", "Pelkin fracture", "Wimberger ring sign", and para-epiphyseal subperiosteal hematoma. Prompt intervention with vitamin C thwarts the progression to severe complications. Radiology is an indispensable tool in diagnosing pediatric scurvy, especially in developmental countries where the assessment of vitamin C serum levels is inaccessible.
PubMed: 38800077
DOI: 10.1016/j.radcr.2024.04.027 -
Structural Heart : the Journal of the... May 2024Inferior outcomes with ACURATE neo, a self-expanding transcatheter heart valve (THV) for the treatment of severe aortic stenosis, were mainly driven by higher rates of... (Review)
Review
Inferior outcomes with ACURATE neo, a self-expanding transcatheter heart valve (THV) for the treatment of severe aortic stenosis, were mainly driven by higher rates of moderate/severe paravalvular leak (PVL). To overcome this limitation, the next-generation ACURATE neo2 features a 60% larger external sealing skirt. Data on long-term performance are limited; however, clinical evidence suggests improved short-term performance which is comparable to contemporary THVs. This report reviews data on short-term clinical and echocardiographic outcomes of ACURATE neo2. A PubMed search yielded 13 studies, including 5 single arm and 8 nonrandomized comparative studies with other THVs which reported in-hospital or 30-day clinical and echocardiographic outcomes. In-hospital or 30-day all-cause mortality was ≤3.3%, which is comparable to other contemporary THVs. The rates of postprocedural ≧moderate PVL ranged 0.6%-4.7%. In multicenter propensity-matched analyses, neo2 significantly reduced the rate of ≧moderate PVL compared to neo (3.5% vs. 11.3%, p < 0.01), whereas rates were comparable to Evolut Pro/Pro+ (Neo2: 2.0% vs. Pro/Pro+: 3.1%, p = 0.28) and SAPIEN 3 Ultra (Neo2: 0.6% vs. Ultra: 1.1%, p = 0.72). The rate of permanent pacemaker implantation with neo2 was consistently low (3.3%-8.6%) except in one study, and in propensity-matched analyses were significantly lower than Evolut Pro/Pro+ (6.7% vs. 16.7%, p < 0.01), and comparable to SAPIEN 3 Ultra (8.1% vs. 10.3%, p = 0.29). In conclusion, ACURATE neo2 showed better short-term performance by considerably reducing PVL compared to its predecessor, with short-term clinical and echocardiographic outcomes comparable to contemporary THVs.
PubMed: 38799801
DOI: 10.1016/j.shj.2023.100277