MR motility imaging in Crohn's disease improves lesion detection compared with standard MR imaging

Objective: To evaluate retrospectively in patients with Crohn's disease (CD) if magnetic resonance (MR) motility alterations correlate with CD typical lesions leading to an increased detection rate. Methods: Forty patients with histologically proven CD underwent MR enterography (MRE), including coronal cine sequences (cine MRE), in addition to the standard CD MR protocol. Two blinded readings were performed with and without cine MRE. Locations presenting motility alterations on the cine sequences were analysed on standard MRE for CD-related lesions. This was compared with a second reading using the standard clinical MRE protocol alone. Results: The number of lesions localised by cine MRE and identified on standard MRE compared with standard MRE alone were 35/24 for wall thickening (p = 0.002), 24/20 for stenoses (p = 0.05), 17/11 for wall layering (p = 0.02), 5/3 for mucosal ulcers (p = 0.02) and 21/17 for the comb sign (p = 0.05). Overall, cine MRE detected 35 more CD-specific findings than standard MRE alone (124/89; p = 0.007) and significantly more patients with CD-relevant MR findings (34/28; p = 0.03). Conclusion: CD lesions seem to be associated with motility changes and this leads to an increased lesion detection rate compared with standard-MRE imaging alon

Stent grafting of acute hepatic artery bleeding following pancreatic head resection

The purpose of this study was to report the potential of hepatic artery stent grafting in cases of acute hemorrhage of the gastroduodenal artery stump following pancreatic head resection. Five consecutive male patients were treated because of acute, life-threatening massive bleeding. Instead of re-operation, emergency angiography, with the potential of endovascular treatment, was performed. Because of bleeding from the hepatic artery, a stent graft (with the over-the-wire or monorail technique) was implanted to control the hemmorhage by preserving patency of the artery. The outcome was evaluated. In all cases, the hepatic artery stent grafting was successfully performed, and the bleeding was immediately stopped. Clinically, immediately after the procedure, there was an obvious improvement in the general patient condition. There were no immediate procedure-related complications. Completion angiography (n=5) demonstrated control of the hemorrhage and patency of the hepatic artery and the stent graft. Although all patients recovered hemodynamically, three individuals died 2 to 10days after the procedure. The remaining two patients survived, without the need for re-operation. Transluminal stent graft placement in the hepatic artery is a safe and technically feasible solution to control life-threatening bleeding of the gastroduodenal artery stum

Ordering CT pulmonary angiography to exclude pulmonary embolism: defense versus evidence in the emergency room

Purpose: To identify reasons for ordering computed tomography pulmonary angiography (CTPA), to identify the frequency of reasons for CTPA reflecting defensive behavior and evidence-based behavior, and to identify the impact of defensive medicine and of training about diagnosing pulmonary embolism (PE) on positive results of CTPA. Methods: Physicians in the emergency department of a tertiary care hospital completed a questionnaire before CTPA after being trained about diagnosing PE and completing questionnaires. Results: Nine hundred patients received a CTPA during 3years. For 328 CTPAs performed during the 1-year study period, 140 (43%) questionnaires were completed. The most frequent reasons for ordering a CTPA were to confirm/rule out PE (93%), elevated D-dimers (66%), fear of missing PE (55%), and Wells/simplified revised Geneva score (53%). A positive answer for "fear of missing PE” was inversely associated with positive CTPA (OR 0.36, 95% CI 0.14-0.92, p=0.033), and "Wells/simplified revised Geneva score” was associated with positive CTPA (OR 3.28, 95% CI 1.24-8.68, p=0.017). The proportion of positive CTPA was higher if a questionnaire was completed, compared to the 2-year comparison period (26.4 vs. 14.5%, OR 2.12, 95% CI 1.36-3.29, p<0.001). The proportion of positive CTPA was non-significantly higher during the study period than during the comparison period (19.2 vs. 14.5%, OR 1.40, 95% CI 0.98-2.0, p=0.067). Conclusion: Reasons for CTPA reflecting defensive behavior—such as "fear of missing PE”—were frequent, and were associated with a decreased odds of positive CTPA. Defensive behavior might be modifiable by training in using guideline

Pretransplant pulmonary hypertension and long-term allograft right ventricular function

Background: Graft right ventricular (RV) function is compromised directly posttransplant, especially in heart transplantation (HTx) recipients with pretransplant pulmonary hypertension (PH). Graft RV size and systolic function, and the effect of the recipient's pulmonary haemodynamics on the graft extracellular matrix are not well characterised in the patients long-term after HTx. Aim: Comparison of RV size and systolic function in HTx recipients' long-term posttransplant stratified by the presence of pretransplant PH. Methods: HTx survivors ≥2 years posttransplant were divided into group I without pretransplant PH (pulmonary vascular resistance, PVR ≪2.5Wood units, n=37) and group II with PH (PVR ≥2.5Wood units, n=16). RV size and systolic function were measured using cardiac magnetic resonance imaging (CMR). The collagen content was assessed in septal endomyocardial biopsies obtained at HTx and at study inclusion. Results: Mean posttransplant follow-up was 5.2±2.9 years (group I) and 4.9±2.2 years (group II) (p=0.70). PVR was 1.5±0.6 vs 4.1±1.7Wood units pretransplant (p≪0.001), and 1.2±0.5 vs 1.3±0.5Wood units at study inclusion (p=0.43). Allograft RV size and systolic function were similar in both groups (p always ≥0.07). Collagen content at transplantation and at follow-up were not different (p always ≥0.60). Conclusion: Posttransplant normalisation of pretransplant PH is associated with normal graft RV function long-term after HT

MR motility imaging in Crohn's disease improves lesion detection compared with standard MR imaging

To evaluate retrospectively in patients with Crohn's disease (CD) if magnetic resonance (MR) motility alterations correlate with CD typical lesions leading to an increased detection rate

Pelvic radiography in ATLS algorithms: A diminishing role?

This is an Open Access article distributed under the terms of the Creative Commons Attribution Licens

The Evolution from Design to Verification of the Antenna System and Mechanisms in the AcubeSAT mission

AcubeSAT is an open-source CubeSat mission aiming to explore the effects of microgravity and radiation on eukaryotic cells using a compact microfluidic LoC platform. It is developed by SpaceDot, a volunteer, interdisciplinary student team at the Aristotle University of Thessaloniki and supported by the "Fly Your Satellite! 3" program of the ESA Education Office. The scientific data of the mission is comprised of microscope images captured through the on-board integrated camera setup. As the total size of the payload data is expected to be close to 2GB over 12 months, a fast and efficient downlink fulfilling the restrictive power, cost and complexity budgets is required. Currently, there is no open-source communications system design which fully supports these specific constraints, so we opted to develop our own solutions. The antenna system underwent multiple iterations as the design matured, a process highly aided by the feedback received from the ESA experts. The final communications system configuration consists of an S-band microstrip antenna operating at 2.4GHz and a UHF deployable antenna, for the payload data and TM&TC respectively, both in-house designed. In this paper, we will present AcubeSAT's antenna system iterations that span over 3 years, as well as the rationale and analysis results behind each. The development decisions will be highlighted throughout the paper in an effort to aid in the future development of such a low-cost CubeSat mission communications system.Comment: 74th International Astronautical Congres

Computer- und Magnetresonanztomographie sowie EUS zur Diagnostik von Pankreastumoren

Jede optimierte Therapie basiert auf einer bestmöglichen Diagnostik. Speziell für das Pankreas kommt dabei der Bildgebung ein hoher Stellenwert zu. Die Qualität der Diagnostik wird generell gemessen als diagnostische Genauigkeit, welche von einer Vielzahl an Faktoren abhängt. Der Anwender sollte mit diesen vertraut sein, um für die jeweiligen Fragestellungen und Patienten zum gegebenen Zeitpunkt die dafür am besten geeigneten Bildmodalitäten/-verfahren wählen zu können. Zur Verfügung stehen hierbei im Wesentlichen das Computertomogramm (CT), die Magnetresonanz-Tomographie (MRT) und der endoskopische Ultraschall (EUS). Diese Verfahren werden insbesondere in Hinblick auf die Diagnostik des Pankreaskarzinoms und mit besonderem Augenmerk auf Schwierigkeiten in der Differenzierung zur autoimmunen oder chronischen Pankreatitis vorgestellt und diskutiert

Abdominal magnetic resonance imaging in small rodents using a clinical 1.5 T MR scanner

Because of superior soft-tissue contrast compared to other imaging techniques, non-invasive abdominal magnetic resonance imaging (MRI) is ideal for monitoring organ regeneration, tissue repair, cancer stage, and treatment effects in a wide variety of experimental animal models. Currently, sophisticated MR protocols, including technically demanding procedures for motion artefact compensation, achieve an MRI resolution limit of < 100 microm under ideal conditions. However, such a high spatial resolution is not required for most experimental rodent studies. This article describes both a detailed imaging protocol for MR data acquisition in a ubiquitously and commercially available 1.5 T MR unit and 3-dimensional volumetry of organs, tissue components, or tumors. Future developments in MR technology will allow in vivo investigation of physiological and pathological processes at the cellular and even the molecular levels. Experimental MRI is crucial for non-invasive monitoring of a broad range of biological processes and will further our general understanding of physiology and disease