Austin Brown, Heath Jolliff, Douglas Poe, Michael Weinstock
INTRODUCTION: Diplopia is an uncommon emergency department (ED) complaint representing only 0.1% of visits, but it has a large differential. One cause is a cranial nerve palsy, which may be from a benign or life-threatening process. CASE REPORT: A 69-year-old female presented to the ED with two days of diplopia and dizziness. The physical exam revealed a sixth cranial nerve palsy isolated to the left eye. Imaging demonstrated an intracavernous internal carotid artery aneurysm...
August 2020: Clinical Practice and Cases in Emergency Medicine
Elisabetta C Del Re, William S Stone, Sylvain Bouix, Johanna Seitz, Victor Zeng, Anthony Guliano, Nathaniel Somes, Tianhong Zhang, Benjamin Reid, Amanda Lyall, Monica Lyons, Huijun Li, Susan Whitfield-Gabrieli, Matcheri Keshavan, Larry J Seidman, Robert W McCarley, Jijun Wang, Martha E Shenton, Margaret A Niznikiewicz
OBJECTIVE: To assess cortical thickness (CT) and surface area (SA) of frontal, temporal, and parietal brain regions in a large clinical high risk for psychosis (CHR) sample, and to identify cortical brain abnormalities in CHR who convert to psychosis and in the whole CHR sample, compared with the healthy controls (HC). METHODS: Magnetic resonance imaging, clinical, and cognitive data were acquired at baseline in 92 HC, 130 non-converters, and 22 converters (conversion assessed at 1-year follow-up)...
September 14, 2020: Schizophrenia Bulletin
Nicholas A George-Jones, Anthony M Tolisano, J Walter Kutz, Brandon Isaacson, Jacob B Hunter
OBJECTIVE: We sought to examine the intra- and interobserver variability in measuring the cochlear duct length (CDL) from magnetic resonance imaging (MRI) images versus computed tomography (CT) images using an otological surgical planning software that uses measurements of the basal turn diameter and cochlear width to estimate the CDL. PATIENTS: Twenty-one adult cochlear implant patients with preoperative MRI and CT images. INTERVENTION: Three fellowship-trained neurotologists served as the raters in the study...
October 2020: Otology & Neurotology
Joshua Davis, Melissa Chima, Kathryn Kasmire
INTRODUCTION: Appendicitis is a common pediatric surgical emergency, and it can often be difficult to diagnose. Computed tomography is commonly used as a diagnostic criterion standard, but herein, we describe the accuracy of a "radiation-free" diagnostic algorithm using point-of-care ultrasonography (POCUS) and magnetic resonance imaging (MRI) to diagnose pediatric appendicitis. METHODS: This was a retrospective chart review of all patients who had a POCUS ordered for evaluation of pediatric appendicitis...
September 10, 2020: Pediatric Emergency Care
Jerrad Businger, Alexander C Fort, Phillip E Vlisides, Miguel Cobas, Ozan Akca
Acute ischemic stroke is a neurological emergency with a high likelihood of morbidity, mortality, and long-term disability. Modern stroke care involves multidisciplinary management by neurologists, radiologists, neurosurgeons, and anesthesiologists. Current American Heart Association/American Stroke Association (AHA/ASA) guidelines recommend thrombolytic therapy with intravenous (IV) alteplase within the first 3-4.5 hours of initial stroke symptoms and endovascular mechanical thrombectomy within the first 16-24 hours depending on specific inclusion criteria...
October 2020: Anesthesia and Analgesia
M Georgieva, S Kammerer, L Prantl, F Jung, C Stroszczynski, E M Jung
BACKGROUND: In recent years, follow-up after breast reconstruction with silicone implants and the detection of complications have been relieved by the possibility of improved diagnostic methods. METHODS: Between January 2015 and December 2019 a total of 40 patients (29-84 years) with silicone implants were included in this retrospective study. The implants were examined clinically and with modern imaging: general ultrasound imaging (US), magnetic resonance imaging (MRI), high resolution computed tomography (CT) and positron emission tomography -computed tomography (PET-CT)...
September 8, 2020: Clinical Hemorheology and Microcirculation
V Schwarze, C Marschner, W Völckers, G Negrão de Figueiredo, J Rübenthaler, D-Á Clevert
BACKGROUND: HCC is the most frequent primary liver cancer entity. Major risk factors comprise chronic HBC and HCV infections, ALD or NAFLD. Apart from the anamnesis, the clinical examination and serologic analysis, an essential part of the diagnostic HCC work-up is due to imaging findings from sonography, CT or MRI scans. HCC lesions feature a distinct vascularization pattern: hyperenhancement during early arterial and hypoenhancement/wash-out during portal venous or delayed phases. CEUS facilitates dynamic assessment of microperfusion patterns of suspicious liver lesions...
September 7, 2020: Clinical Hemorheology and Microcirculation
Alessandra Cocca, Dominic Thompson, Zehan Rahim, Melita Irving, Michael Farquhar, Rui Santos, Moira S Cheung
Achondroplasia is associated with foramen magnum stenosis. We report a male infant with achondroplasia and centrally mediated obstructive apnoea who underwent two foramen magnum decompression due to bone regrowth. He presented at six weeks of age with breath holding and apnoeic episodes associated with significant desaturation, requiring non-invasive ventilation. Craniospinal imaging revealed a narrow foramen magnum without signal change in the spinal cord. Sleep studies showed obstructive, but not central, apnoea...
September 12, 2020: British Journal of Neurosurgery
Gabriel Santos Vázquez, Ricardo Garcia Cázarez, Erick Moreno Pizarro, Aarón Emanuel Serrano Padilla, Juan Carlos Plascencia Salcedo
Miliary metastasis to the central nervous system (CNS) is a rare presentation of metastasis mainly found in primary adenocarcinoma of the lung. Its association with breast cancer is even less frequent. We present the case of a 50-year-old female patient diagnosed in 2010 with stage IIA infiltrating ductal breast cancer RE (-), RP (+), HER 2 (-), HER2 NEU (+). She was treated with modified radical left breast mastectomy, radiation therapy, and chemotherapy. Her condition began presenting oppressive frontal headache without irradiation, predominantly in the evening, intensity 8/10, which decreased when sleeping and was exacerbated with stressful situations, in addition to progressive cognitive deterioration...
August 10, 2020: Curēus
Suman Rao, Zachariah Nealy, Alisha Khan, Christopher Nardone
Patients with heart metastases could present insidiously, with symptoms that mimic those of congestive heart failure or acute coronary syndrome. Our patient initially presented with vague lower sternal and abdominal pain and had a past medical history of coronary artery disease. Her first two troponin levels were elevated, and her EKG was significant for ischemic changes. Echocardiography showed a large mass in the right ventricle and the presence of pericardial effusion. CT scan of the thorax, abdomen, and pelvis showed multiple pulmonary nodules as well as liver metastases...
August 9, 2020: Curēus
Carl Christoph Schimanski, Stefan Kasper, Susanna Hegewisch-Becker, Jan Schröder, Friedrich Overkamp, Frank Kullmann, Wolf Otto Bechstein, Matthias Vöhringer, Robert Öllinger, Florian Lordick, Volker Heinemann, Michael Geißler, Armin Schulz-Abelius, Helga Bernhard, Michael R Schön, Richard Greil, Peter Galle, Hauke Lang, Irene Schmidtmann, Markus Moehler
Resection of colorectal liver metastases (CRLM) is a potential curative treatment for patients with metastatic colorectal cancer (mCRC) with liver-limited disease (LLD). Although long-term survival improved considerably within the last decades, high recurrence rates of 50-75% after resection remain a major challenge.Tecemotide (L-BLP25) is an antigen-specific cancer vaccine inducing immunity against mucin-1 (MUC1). The LICC trial aimed to improve survival in patients with mCRC after R0/R1 resection of CRLM...
August 23, 2020: Oncoimmunology
Jae H Yoon, Young J Goo, Chae-Jun Lim, Sung K Choi, Sung B Cho, Sang S Shin, Chung H Jun
BACKGROUND: Extrahepatic metastasis (EHM) of hepatocellular carcinoma (HCC) is associated with poor outcomes. However, the clinical features and risk factors of EHM of HCC after radiofrequency ablation (RFA) remain unclear. AIM: To elucidate the characteristics and risk factors of EHM after RFA for HCC. METHODS: From January 2008 to December 2017, we retrospectively enrolled 661 patients who underwent RFA as first-line treatment for HCC at 2 tertiary hospitals...
August 28, 2020: World Journal of Gastroenterology: WJG
Roberto Cannella, Ludovico La Grutta, Massimo Midiri, Tommaso Vincenzo Bartolotta
Gastrointestinal stromal tumors (GISTs) are uncommon neoplasms of the gastrointestinal tract with peculiar clinical, genetic, and imaging characteristics. Preoperative knowledge of risk stratification and mutational status is crucial to guide the appropriate patients' treatment. Predicting the clinical behavior and biological aggressiveness of GISTs based on conventional computed tomography (CT) and magnetic resonance imaging (MRI) evaluation is challenging, unless the lesions have already metastasized at the time of diagnosis...
August 28, 2020: World Journal of Gastroenterology: WJG
Atsushi Suzuki, Amanda J Deisher, Maryam E Rettmann, H Immo Lehmann, Stephan Hohmann, Songyun Wang, Hiroki Konishi, Jon J Kruse, Jack T Cusma, Laura K Newman, Kay D Parker, Kristi H Monahan, Michael G Herman, Douglas L Packer
Background - Proton beam therapy offers radiophysical properties that are appealing for noninvasive arrhythmia elimination. This study was conducted to use scanned proton beams for ablation of cardiac tissue, investigate electrophysiologic outcomes, and characterize the process of lesion formation in a porcine model using particle therapy. Methods - Twenty-five animals received scanned proton beam irradiation. ECG-gated CT scans were acquired at end-expiration breath hold. Structures (atrioventricular junction [AVJ] or left ventricular myocardium [LV]) and organs at risk were contoured...
September 13, 2020: Circulation. Arrhythmia and Electrophysiology
Dominic Gascho, Eva Deininger-Czermak, Niklaus Zoelch, Carlo Tappero, Stefan Sommer, Natalie Hinterholzer, Michael J Thali
Compared to computed tomography (CT), magnetic resonance imaging (MRI) provides superior visualization of the soft tissue. Recently, the first 7 Tesla (7 T) MRI scanner was approved for clinical use, which will facilitate access to these ultra-high-field MRI scanners for noninvasive examinations and scientific studies on decedents. 7 T MRI has the potential to provide a higher signal-to-noise ratio (SNR), a characteristic that can be directly exploited to improve image quality and invest in attempts to increase resolution...
September 12, 2020: Forensic Science, Medicine, and Pathology
Liang Dong, Yinjie Zhu, Mei Xin, Baijun Dong, Jiahua Pan, Jianjun Liu, Sarah R Amend, Wei Xue, Kenneth J Pienta, Steven P Rowe
The purpose of this study was to prospectively evaluate the distribution of PSMA-targeted, PET-avid lesions in prostate cancer (PCa) patients with biochemical recurrence in a Chinese cohort. The relationships between PSA levels, disease-free time after prostatectomy, and 68 Ga-PSMA-11 PET/computed tomography (CT) findings were investigated. Inclusion criteria included histopathologically proven prostate adenocarcinoma, two consecutive PSA levels > 0.20 ng/mL, and negative CT of the abdomen and pelvis or magnetic resonance imaging of the pelvis and whole-body bone scan...
September 12, 2020: Medical Oncology
Amit G Singal, Sruthi Patibandla, Joseph Obi, Hannah Fullington, Neehar D Parikh, Adam C Yopp, Jorge A Marrero
BACKGROUND: The value of a cancer screening programs is defined by its balance of benefits and harms; however, there are few data evaluating both attributes for hepatocellular carcinoma (HCC) surveillance. We aimed to characterize benefits and harms of HCC surveillance in a large prospective cohort of patients with cirrhosis. METHODS: We conducted a secondary analysis of a clinical trial evaluating HCC surveillance among patients with cirrhosis at a safety-net health system enrolled between December 2014 and July 2015...
September 10, 2020: Clinical Gastroenterology and Hepatology
Yoshinori Ishikawa, Naohisa Miyakoshi, Michio Hongo, Yuji Kasukawa, Daisuke Kudo, Chiaki Sato, Yoichi Shimada
BACKGROUND: Cervical ossification of the ligamentum flavum (OLF) is a rare condition; however, the coexistence of OLF and ossification of the posterior longitudinal ligament (OPLL) is extremely uncommon. These can exist simultaneously and cause thinning of the cervical spinal cord. Sufficient decompression, dural ossification, semispinalis dissection, and postoperative kyphosis were evaluated. We report the successful treatment of coexisting cervical OLF and OPLL. CASE DESCRIPTION: A 70-year-old man had been experiencing weakness in the left knee and clumsiness in the left hand for 6 months...
September 10, 2020: World Neurosurgery
Federica Tosi, Andrea Sartore-Bianchi, Sara Lonardi, Alessio Amatu, Francesco Leone, Silvia Ghezzi, Cosimo Martino, Katia Bencardino, Erica Bonazzina, Francesca Bergamo, Elisabetta Fenocchio, Erika Martinelli, Teresa Troiani, Giulia Siravegna, Gianluca Mauri, Valter Torri, Giovanna Marrapese, Emanuele Valtorta, Andrea Cassingena, Giovanni Cappello, Emanuela Bonoldi, Angelo Vanzulli, Daniele Regge, Fortunato Ciardiello, Vittorina Zagonel, Alberto Bardelli, Livio Trusolino, Silvia Marsoni, Salvatore Siena
BACKGROUND: ERBB2 amplification occurs in 5% of RAS wild-type metastatic colorectal cancer (mCRC) and it has been shown to be a target for treatment with 2 HER2-directed combinations of trastuzumab and lapatinib or trastuzumab and pertuzumab. We present long-term clinical results of trastuzumab and lapatinib (HERACLES-A trial) at 6.7 years (82 months) follow-up and focus on central nervous system (CNS) recurrences. PATIENTS AND METHODS: Patients had histologically confirmed KRAS exon 2 (codons 12 and 13) wild-type and HER2-positive mCRC...
June 27, 2020: Clinical Colorectal Cancer
Shae Anderson, Janet Figueroa, Courtney E McCracken, Charles Cochran, Timothy C Slesnick, William L Border, Ritu Sachdeva
BACKGROUND: Concern exists over exponential growth in cardiac imaging in adults, but there is paucity of such data for cardiac imaging trends in pediatric patients. The aims of this study were to determine temporal trends in the use of noninvasive cardiac imaging and compare these with trends in the use of noncardiac imaging and to identify factors influencing those trends using the Pediatric Health Information Service database. METHODS: Pediatric inpatient encounter data from January 2004 to December 2017 at 35 pediatric hospitals were extracted from the Pediatric Health Information Service database...
September 9, 2020: Journal of the American Society of Echocardiography
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