CT dose management for neurologic events in patients with cardiac devices: Radiation exposure variation in patients with cardiac devices

PURPOSE:To compare the inter-center cranial computed tomography (CT) acquisition rates, CT findings, CT related radiation dose, and variability of CT acquisition parameters for neurologic events among patients with implantable cardioverter-defibrillator (ICD) or left ventricular assist device (LVAD).METHODS:A total of 224 patients [ICD group (n = 155) and LVAD group (n = 69)] who had at least one cranial CT scan were enrolled from three medical centers. The variability and effect of the number, indication, and findings of cranial CT scans as well as CT acquisition parameters including tube potential, tube current, tube rotation time (TI), slice collimation (cSL), and spiral or sequential scanning techniques on CT dose index volume (CTDIvol), total dose length product (DLP) were analyzed.RESULTS:The mean DLP value of Center A and mean CTDIvol values of Center A and C were significantly lower than Center B (p < 0.001). The mean CTDIvol and DLP values in the ICD group were substantially lower than the LVAD group (p<0.001). The most potent parameters causing the changes in CTDIvol and DLP were kV, mAs values, and CT scanning technique as sequential or spiral according to multivariate linear regression analysis.CONCLUSION:Cranial CT acquisition parameters and radiation doses vary significantly between centers, which necessitates optimization of cranial CT protocols to overcome the cumulative radiation dose burden in patients with neurologic events

Traumatic craniocervical junction ligamentous and brain stem injuries and retroclival hematoma: unusual combination of craniocervical junction injuries

Cervical spine injuries are common in pediatric population and usually seen in craniocervical junction due to the anatomical and physiological differences. Combination of rapid hyperextension/hyperflexion traumas due to highspeed motor vehicle accident are known to be the reason of ligamentous injury and retroclival epidural hematoma. Our aim is to describe a rare combination injury of the the apical ligament, retroclival epidural hematoma and the suspicion of brain stem slits, due to rapid hyperextension/hyperflexion and rotational trauma with high-speed motor vehicle accident in a 3 year 8 month old girl. The cervical spine was immobilized with a Philadelphia collar. She is still under treatment in the pediatric intensive care unit with a Glascow Coma Scale of 8 for six months

Unexpected inconsistency of cranial MRI and cranial US measurements: new normative values in the neonatal period

Ultrazvuk (UZV) lubanje omogućava razlikovanje normalnog od nenormalnog u razumnom vremenu snimanja i bez zračenja. Međutim, nema dovoljno podataka o usporedbi mjerenja provedenih pomoću UZV-a glave i magnetskom rezonancom (MR) mozga za neke intrakranijske strukture u novorođenčadi. Cilj studije bio je procijeniti pouzdanost UZV glave u usporedbi s MR-om mozga. Također smo tražili referentne vrijednosti za hipofi zu i infundibulum, što je važno kad se procjenjuje postoji li zaostajanje u rastu ili nenormalan rast u ovoj populaciji. Normativna mjerenja širine 4. i 3. lateralnog ventrikula, dužina i širina korpusa kalozuma (CC), biventrikulska širina (BVW) i biparijetalni promjer (BPD) prospektivno su bilježeni u 95-ero zdrave terminske novorođenčadi na UZV-u glave i MR-u mozga. Uz te poznate strukture, na MR-u smo također mjerili visinu hipofi ze, debljinu infundibuluma, visinu i širinu cerebeluma. Usporedba UZV-a lubanje i MR-a mozga pokazala je dobru korelaciju za BPD, širinu splenija i koljena CC-a, anteroposteriornu dužinu CC-a i širinu 3. ventrikula (κ=0,88-0,99). Korelacija je bila slaba za BVW, širinu korpusa CC-a i širinu lateralnih ventrikula (κ=0,28-0,56). Nove normativne vrijednosti za visinu hipofi ze i debljinu peteljke u novorođenačkoj dobi novi su nalazi ove prospektivne studije. U zaključku, mjerenja zabilježena pomoću UZV-a lubanje i MR-a nisu bila dosljedna u nekim moždanim strukturama. Bitno je znati normativne vrijednosti i diferencirati prirođene i razvojne anomalije mozga u novorođečadi. Također su utvrđene nove referentne vrijednosti za hipofi zu i infundibulum u novorođenačkoj dobi.Cranial ultrasonography (US) enables diff erentiation of normal from abnormal in a reasonable scanning time and without radiation. However, there is not enough data comparing measurements of cranial US and magnetic resonance imaging (MRI) for some intracranial structures in the neonatal period. We aimed to assess the reliability of cranial US compared with brain MRI. We also sought reference values of the pituitary gland and infundibulum, which is important in searching for growth retardation or abnormal growth in this population. Normative measurements of the width of the 4th, 3rd and lateral ventricles, length and width of the corpus callosum (CC), biventricular width (BVW), and biparietal diameter (BPD) were prospectively obtained from 95 healthy fullterm neonates on both cranial US and brain MRI. Besides the well-known structures, the height of the pituitary gland, thickness of the infundibulum, height and width of the cerebellum were measured on MRI. Comparison of cranial US and brain MRI showed good correlation in the BPD, width of the splenium and genu of CC, anteroposterior length of CC, and width of the 3rd ventricle (κ=0.88- 0.99). Correlation was poor in BVW, width of the corpus of CC, and width of the lateral ventricles (κ=0.28-0.56). New normative values of the height of pituitary gland and thickness of the stalk in the neonatal period are novel fi ndings of this prospective study. In conclusion, cranial US and MRI measurements were not consistent in some brain structures. It is crucial to know the normative values, and to diff erentiate congenital and developmental brain anomalies in the neonatal period. The new reference values of the pituitary gland and infundibulum were also established in this period

Ovarian and Renal Vein Thrombosis: A Rare Cause of Fever Outer the Postpartum Period

Although there is no other underlying disease, women can sometimes experience rare and serious diseases such as ovarian vein thrombosis (OVT) and renal vein thrombosis (RVT) after giving birth. The widespread development of thrombosis is treated for the first time in this study. Stasis, coagulation factor abnormalities, and intimal damage to the venous thrombosis risk can increase during pregnancy. It was mentioned that it diagnoses an abnormality in the hypercoagulability half of women with OVT. Despite the hypercoagulant abnormality observed in pregnant women, it was very unusual that the renal vein thrombosis led to this complication. It can lead to severe complication of OVT which can even cause death. It was the first time that the renal vein and ovarian vein thrombosis were observed in the postpartum period, and there was no coagulation abnormality. It is known that the thrombus in the postpartum period can be observed with the fever of unknown origin. The problematic, but rarely observed, postpartum disease such as ovarian venous thrombosis (OVT) is generally observed in the right ovarian vein. In this disease, avoiding the resulting laparotomy heparin and intravenous antibiotics is best solution for the patient. If it is to be noted a fever for unknown reasons, that it be thrombosis

Association between treatment with coil embolization of renal artery aneurysm and resistant hypertension

Hypertension is the number one risk factor in preventable causes of death in the world. Resistant hypertension is defined as blood pressure that remains uncontrolled despite at least three antihypertensive medications including a diuretic. Treatment of hypertension includes many modalities from lifestyle changing to multiple drug using, angioplasty. In this case report, we aim to emphasize the effects of renal artery aneurysm treatment on resistant hypertension

Intravesical BCG immunotherapy: Sepsis and multiorgan failure developed after traumatic catheterization

Intravesical Bacillus Calmette-Guerin (BCG) instillation is a prophylactic therapy using for treating bladder cancer to prevent tumour progression and recurrence. Both local and systemic complications can arise after the installation. Although local complications are common , this therapy is generally well tolerated. Systemic complications are rarely than local complications but can be fatal. We report a case who died from severe complications such as sepsis, pneumonia, renal failure and granulomatous hepatitis after receiving the first maintanence installation of intravesical BCG immunotherapy for bladder transitional cell carcinoma

The importance of craniovertebral and cervicomedullary angles in cervicogenic headache

PURPOSE Many studies have indicated that cervicogenic headache may originate from the cervical structures innervated by the upper cervical spinal nerves. To date, no study has investigated whether narrowing of the craniovertebral angle (CVA) or cervicomedullary angle (CMA) affects the three upper cervical spinal nerves. The aim of this study was to investigate the effect of CVA and/or CMA narrowing on the occurrence of cervicogenic headache. MATERIALS AND METHODS Two hundred and five patients diagnosed with cervicogenic headache were included in the study. The pain scores of patients were determined using a visual analog scale. The nonheadache control group consisted of 40 volunteers. CVA and CMA values were measured on sagittal T2-weighted magnetic resonance imaging (MRI), on two occasions by two radiologists. Angle values and categorized pain scores were compared statistically between the groups. RESULTS Intraobserver and interobserver agreement was over 97% for all measurements. Pain scores increased with decreasing CVA and CMA values. Mean angle values were significantly different among the pain categories (P < 0.001). The pain score was negatively correlated with CMA (Spearman correlation coefficient, r(s), -0.676; P < 0.001) and CVA values (r(s), -0.725; P < 0.001). CONCLUSION CVA or CMA narrowing affects the occurrence of cervicogenic headache. There is an inverse relationship between the angle values and pain scores

The effect of pneumoperitoneum on the cross-sectional areas of internal jugular vein and subclavian vein in laparoscopic cholecystectomy operation

Background: Increased central venous pressure secondary to an increase in intraabdominal pressure has been reported during laparoscopic surgery. However, no study has yet determined the effect of pneumoperitoneum on cross-sectional area (CSA) of central veins by ultrasonography during laparoscopic cholecystectomy. Herein, we aimed to quantify changes in CSAs of internal jugular (IJV) and subclavian veins (SCV) by ultrasonography during this surgery. Methods: This study included 60 ASA I-II patients scheduled for laparoscopic cholecystectomy surgery under general anesthesia. Pneumoperitoneum was performed with CO2 at 12 mmHg. The CSAs of right IJV and right SCV were measured using a 6 Mhz ultrasonography transducer in supine and neutral positions before anesthesia induction (T1), 5 min after connecting to mechanical ventilator (T2), 5 min after creation of pneumoperitoneum (T3), at the end of pneumoperitoneum (T4), and 5 min after desufflation and before extubation (T5) both at end-expiration and end-inspiration. Results: The comparison of IJV CSA at inspiration showed significant increase in T3 value compared to T2 value (p < 0.001). Similarly the expiratory measurements of IJV CSA demonstrated significant increase in T3 value compared to T2 value (p < 0.001). The comparison of inspiratory CSA measurements of SCV showed significantly increased in T3 (p = 0.009) than T2 value. In expiratory measurements there was a significant increase in T3 (p = 0.032) value compared to T2. All measurements of IJV and SCV SCAs both end-inspiration and end-expiration T5 values significantly decreased compared to T4 values (p < 0.001). Conclusions: Pneumoperitoneum with an intraabdominal pressure of 12 mmHg produces significant increases in IJV and SCV CSAs during laparoscopic cholecystectomy procedure. We believe that this finding may enhance our understanding of pneumoperitoneum-induced hemodynamic changes and facilitate catheterization attempts