Clinical features and presentation of cervicofacial infection : a maxillofacial trainee research collaborative (MTReC) study

Introduction Cervicofacial infection (CFI) is a common presentation to the Oral and Maxillofacial (OMFS) department and accounts for significant emergency activity. The current study aims to understand the aetiology, management and clinical features of patients hospitalised with CFI. Methods Our study included all patients admitted for management of CFI from May to October 2017 at 25 OMFS units across 17 UK regions. Data were collected prospectively and included age, comorbidities, prior treatment received, markers of sepsis and presenting clinical features. Results One thousand and two (1002) admissions were recorded; 546 (54.5%) were male. Median age was 34 years (1-94 years). The most common presenting complaints were trismus (46%) and dysphagia (27%). Airway compromise was present in 1.7% of cases. Odontogenic infection accounted for 822/1002 (82%) admissions. Of those with an infection of odontogenic origin, 453/822 (55.1%) had received previous treatment. Two-thirds of those who had received treatment were managed by antibiotics alone (300/453, 66.2%) Patients met criteria for sepsis in 437/1002 (43.6%) of CFI, and in 374/822 (45.5%) of odontogenic infections. Conclusion This is the largest study worldwide of patients requiring inpatient management for CFI. Infection due to odontogenic origin is the most frequent reason for admission and nearly half do not seek treatment before presentation. Patients with CFI often present late in their disease and frequently meet criteria for sepsis, requiring timely and aggressive treatment to ensure optimum outcomes. Trismus is an emerging dominant feature with all the implications related to the anaesthetic management of these patients. Knowledge of these factors has implications for the referrer, triage, the emergency department, the anaesthetic team and members of the OMFS team

Prognostic value of different CT measurements in early therapy response evaluation in patients with metastatic colorectal cancer

OBJECTIVES: Patients with advanced stage colorectal carcinoma (CRC) display hepatic metastases on initial staging in up to 20% of cases. The effectiveness of chemotherapy is generally evaluated by computed tomography (CT) imaging using standardized criteria (RECIST). However, RECIST is not always optimal, and other criteria have been shown to correlate with pathologic response and overall survival. The aim of this study was to evaluate the prognostic value of different CT measurement for response assessment after initiation of chemotherapy in patients with synchronous colorectal cancer liver metastases. METHODS: Fifty-five patients with CRC and synchronous hepatic metastases were evaluated retrospectively at 2 academic centers. Different size, volume, ratio and attenuation parameters were determined at baseline and after 3 cycles of chemotherapy. The prognostic value of baseline measurements and of the change between baseline and second measurements was analyzed using Kaplan-Meier estimates. RESULTS: Median time to progression was 279 days, median overall survival was 704 days. In this selective patient population, neither a significant prognostic value of initial baseline CT parameters nor a prognostic value of the change between the first and the second CT measurements was found. CONCLUSION: Initial morphological response assessment using different CT measurements has no prognostic value concerning time to progression or overall survival in patients with synchronous colorectal liver metastases

Spectrum of imaging findings in Salmonella infections

10.2214/AJR.11.7621American Journal of Roentgenology1986W534-W539AJRO

Computed tomography features in enteric fever

Annals of the Academy of Medicine Singapore417281-286AAMS

Erratum: Magnetic resonance elastography and diffusion weighted imaging in the evaluation of hepatic fibrosis in chronic hepatitis B (Gut and Liver (2017) 11:3 (401-408) DOI: 10.5009/gnl16079)

10.5009/gnl14041Gut and Liver14453

Clinical presentation, diagnosis, and staging of cholangiocarcinoma

Cholangiocarcinoma (CCA) is a heterogeneous group of tumours, derived from cells of the biliary tree, which represent the second most frequent primary liver tumour. According to the most recent classifications, CCA can be subdivided in intrahepatic (iCCA) and extrahepatic (eCCA) which include perihilar (pCCA) and distal (dCCA) CCA. CCA are usually identified at advanced stages, when the primary tumour grows enough to produce a large liver mass or when jaundice has developed due to biliary tree obstruction. The ongoing challenges in the identification of risk factors and definition of an specific population at higher risk of developing CCA are the main challenges for the development of screening programs. Therefore, late diagnosis remains an unresolved issue in CCA. Imaging plays an important role in the detection and characterization of CCA, helping with radiological diagnosis, guiding biopsy procedures and allowing staging of the tumour. This review focuses on clinical presentations and diagnosis and staging techniques of CCA. This article is protected by copyright. All rights reserved