Neither MRI, CT nor US is superior to diagnose tumors in the salivary glands – an extended case study

OBJECTIVES: Ultrasonography (US), computed tomography (CT) and magnetic resonance imaging (MRI) are the most common radiological procedures for the diagnosis of tumor-like lesions of the salivary glands. The aim of the present study was to determine whether MRI or CT provide additional information besides that delivered by US. STUDY DESIGN/METHODS: 109 patients with a tumor-like lesion of the salivary glands underwent surgery. MRI and CT were arranged in 73 and in 40 patients respectively, whereas all 109 patients were prospectively diagnosed by US. The results of CT, MRI and US were compared with the histological outcome. Furthermore, the recent rise in the number of CT and MRI studies was investigated. RESULTS: On CT and MRI, there was no rise in the percentage of malignant tumors or advanced surgical procedures. In respect of the radiological assessment of the lesion (benign/malignant) and the correct diagnosis, CT, MRI and US were comparable in terms of sensitivity, specificity and accuracy. No significant difference was found in the Chi-square test (p > 0.05). CONCLUSION: The evaluation of the preoperative results of CT, MRI and US revealed no advantage for CT or MRI; these procedures are only required in specific cases. An update or revision of the current preoperative diagnostic management is deemed necessary

Prospective study on the mismatch concept in acute stroke patients within the first 24 h after symptom onset - 1000Plus study

<p>Abstract</p> <p>Background</p> <p>The mismatch between diffusion weighted imaging (DWI) lesion and perfusion imaging (PI) deficit volumes has been used as a surrogate of ischemic penumbra. This pathophysiology-orientated patient selection criterion for acute stroke treatment may have the potential to replace a fixed time window. Two recent trials - DEFUSE and EPITHET - investigated the mismatch concept in a multicenter prospective approach. Both studies randomized highly selected patients (n = 74/n = 100) and therefore confirmation in a large consecutive cohort is desirable. We here present a single-center approach with a 3T MR tomograph next door to the stroke unit, serving as a bridge from the ER to the stroke unit to screen all TIA and stroke patients. Our primary hypothesis is that the prognostic value of the mismatch concept is depending on the vessel status. Primary endpoint of the study is infarct growth determined by imaging, secondary endpoints are neurological deficit on day 5-7 and functional outcome after 3 months.</p> <p>Methods and design</p> <p>1000Plus is a prospective, single centre observational study with 1200 patients to be recruited. All patients admitted to the ER with the clinical diagnosis of an acute cerebrovascular event within 24 hours after symptom onset are screened. Examinations are performed on day 1, 2 and 5-7 with neurological examination including National Institute of Health Stroke Scale (NIHSS) scoring and stroke MRI including T2*, DWI, TOF-MRA, FLAIR and PI. PI is conducted as dynamic susceptibility-enhanced contrast imaging with a fixed dosage of 5 ml 1 M Gadobutrol. For post-processing of PI, mean transit time (MTT) parametric images are determined by deconvolution of the arterial input function (AIF) which is automatically identified. Lesion volumes and mismatch are measured and calculated by using the perfusion mismatch analyzer (PMA) software from ASIST-Japan. Primary endpoint is the change of infarct size between baseline examination and day 5-7 follow up.</p> <p>Discussions</p> <p>The aim of this study is to describe the incidence of mismatch and the predictive value of PI for final lesion size and functional outcome depending on delay of imaging and vascular recanalization. It is crucial to standardize PI for future randomized clinical trials as for individual therapeutic decisions and we expect to contribute to this challenging task.</p> <p>Trial Registration</p> <p>clinicaltrials.gov NCT00715533</p

"Erzählen Sie es doch ihrem Friseur" - ein Fall rezidivierender iatrogener trachealer Trichose als Ursache chronischen Hustens

Hintergrund: Wir berichten über einen 71-jährigen Patienten, der nach Strumektomie und hierbei entstandener beidseitiger Rekurrensparese luftnötig und deshalb tracheotomiert wurde. Nach vier Monaten hatte sich die Beweglichkeit der rechten Stimmlippe soweit erholt, dass dekanüliert und das Tracheostoma verschlossen wurde. Bei einer Wiedervorstellung nach weiteren drei Monaten beklagte der Patient attackenweise starken, nicht produktiven Husten.Material und Methoden: Die Videolaryngoskopie ließ eine transglottisch gelegene faserartige Struktur erkennen. Hieraufhin wurde in Oberflächenanästhesie tracheoskopiert, wobei wir kräftigen Haarwuchs (anfangs 23 Haare) ausgehend vom beim Tracheostomaverschluss eingeschwenkten Hautareal nachwiesen. Nach Rücksprache mit mehreren Dermatologen entwickelten wir ein Konzept zur tracheoskopisch gestützten transkutanen Hochfrequenz-Elektro-Epilation, mit der wir in bisher zwei Eingriffen versuchten, die vorhandenen Haarfollikel per Thermokoagulation zu beseitigen.Ergebnisse: Ein Rezidiv nach 10 Monaten, hierbei waren erneut drei Haare zu sehen, wurde, bislang erfolgreich, gleichartig behandelt.Diskussion: Wir sahen in der Wahl dieser Methodik den schonendsten uns zur Verfügung stehenden Weg, den trachealen Haarwuchs zu beenden