Antiinflammatory Therapy with Canakinumab for Atherosclerotic Disease

Background: Experimental and clinical data suggest that reducing inflammation without affecting lipid levels may reduce the risk of cardiovascular disease. Yet, the inflammatory hypothesis of atherothrombosis has remained unproved. Methods: We conducted a randomized, double-blind trial of canakinumab, a therapeutic monoclonal antibody targeting interleukin-1β, involving 10,061 patients with previous myocardial infarction and a high-sensitivity C-reactive protein level of 2 mg or more per liter. The trial compared three doses of canakinumab (50 mg, 150 mg, and 300 mg, administered subcutaneously every 3 months) with placebo. The primary efficacy end point was nonfatal myocardial infarction, nonfatal stroke, or cardiovascular death. RESULTS: At 48 months, the median reduction from baseline in the high-sensitivity C-reactive protein level was 26 percentage points greater in the group that received the 50-mg dose of canakinumab, 37 percentage points greater in the 150-mg group, and 41 percentage points greater in the 300-mg group than in the placebo group. Canakinumab did not reduce lipid levels from baseline. At a median follow-up of 3.7 years, the incidence rate for the primary end point was 4.50 events per 100 person-years in the placebo group, 4.11 events per 100 person-years in the 50-mg group, 3.86 events per 100 person-years in the 150-mg group, and 3.90 events per 100 person-years in the 300-mg group. The hazard ratios as compared with placebo were as follows: in the 50-mg group, 0.93 (95% confidence interval [CI], 0.80 to 1.07; P = 0.30); in the 150-mg group, 0.85 (95% CI, 0.74 to 0.98; P = 0.021); and in the 300-mg group, 0.86 (95% CI, 0.75 to 0.99; P = 0.031). The 150-mg dose, but not the other doses, met the prespecified multiplicity-adjusted threshold for statistical significance for the primary end point and the secondary end point that additionally included hospitalization for unstable angina that led to urgent revascularization (hazard ratio vs. placebo, 0.83; 95% CI, 0.73 to 0.95; P = 0.005). Canakinumab was associated with a higher incidence of fatal infection than was placebo. There was no significant difference in all-cause mortality (hazard ratio for all canakinumab doses vs. placebo, 0.94; 95% CI, 0.83 to 1.06; P = 0.31). Conclusions: Antiinflammatory therapy targeting the interleukin-1β innate immunity pathway with canakinumab at a dose of 150 mg every 3 months led to a significantly lower rate of recurrent cardiovascular events than placebo, independent of lipid-level lowering. (Funded by Novartis; CANTOS ClinicalTrials.gov number, NCT01327846.

The correlation of the diff usion values in lumbar intervertebral discs with disc degeneration and age

Amaç: Bu çalışmada lomber disklerdeki difüzyon değerlerinin dejenerasyonla ve yaşla olan ilişkisi ADC ölçümleriyle değerlendirildi. Gereç ve Yöntem: Bel ağrısı yakınmasıyla başvuran yaşları 14-64 arasında değişen 50 olguya (24 kadın, 26 erkek) difüzyon ağırlıklı MR görüntüleme uygulandı. T2 ağırlıklı sagital görüntülerde dejenere diskler belirlendi. Dejenere diskler hafif ve ağır olarak gruplandırıldı. Her bir disk düzeyi için ADC değerleri ölçüldü. Normal disklerin ortalama ADC değerlerinin anatomik düzeyle ve yaşla olan ilişkisi değerlendirildi. Dejenere disklerin ortalama ADC değerleri normal disklerle karşılaştırıldı. Bulgular Mann Whitney testi, Kruskal Wallis testi ve Sperman’s korelasyon katsayısıyla analiz edildi. Bulgular: Ortalama ADC değerleri normal disklerde 1.82 ± 0.20 x 10-3 mm2/sn, dejenere disklerde 1.30 ± 0.47 x 10-3 mm2/sn olarak bulundu (p< 0.01). Normal disklerde anatomik düzeyle ortalama ADC değerleri arasında anlamlı ilişki saptanmadı. Yaşla ortalama ADC değerleri arasında negatif korelasyon yönünden anlamlı ilişki mevcuttu. Sonuç: Dejenere disklerin ADC değerleri normal disklere göre belirgin olarak azalmıştır. Dejeneratif disk hastalığının değerlendirilmesinde difüzyon MR görüntüleme son derece faydalı bir yöntem olabilirPURPOSE: To evaluate the correlation of the diffusion values in lumbar intervertebral discs with disc degeneration and age. MATERIALS AND METHODS: Diffusion-weighted imaging of the lumbar spine was performed in fifty patients. ADC values were recorded for each disc. All discs were visually as being normal or as showing at least one of two MR findings of degeneration on sagittal T2 weighted images. Mean ADC values of normal discs were compared with those of degenerated discs and were correlated with age and anatomic location. Data were analyzed by using Mann Whitney test, Kruskal Wallis test, and Sperman s correlation statistics. RESULTS: The mean ADC value was 1.82 &plusmn; 0.20 x 10-3 mm2/sec in normal discs and 1.30 &plusmn; 0.47 x 10-3 mm2/sec in abnormal discs. No a statistically signicifant dependence of lumbar disc ADC on anatomic location was reported. There was a correlation between age and mean ADC values of lumbar discs. CONCLUSION: A statistically significant decrease was seen in the ADC values of degenerated lumbar discs when compared with ADC values of normal discs. Diffusion MR imaging may be useful technique in the evaluation of degenerative disc disease

Anatomic variations of the colon detected an abdominal CT scans

AMAÇ Abdomen BT incelemelerinde saptanan kolonun anatomik varyasyonlarının insidansını ve görünümlerini sunmak. GEREÇ VE YÖNTEM Bölümümüzde ardı ardına çekilen 296 abdomen BT incelemesinde retrorenal kolon, retrogastrik kolon (hepatopankreatik interpozisyon veya retrosplenik kolon), yüksek yerleşimli sağ kolon ve kolonun böbrek ile psoas kası arasına ve hepatodiyafragmatik (anterior veya posterior) interpozisyonu araştırıldı. BULGULAR Biri pankreatikogastrik (%0.3), diğeri retrosplenik (%0.3) 2 olguda retrogastrik kolon; 2 olguda (%0.7) böbrek ile psoas kası arasına interpozisyon; 2 olguda iki taraflı, 3 olguda tek taraflı retrorenal kolon (%1.2); 1 olguda posterior (%0.3), 6 olguda (%2.1) anterolateral hepatodiyafragmatik interposizyon; 4 olguda çekum tamamen subhepatik, 8 olguda sağ alt kadran ile karaciğer arasında ara bir bölgede olmak üzere 12 olguda (%4.2) yüksek yerleşimli sağ kolon saptandı. Subhepatik yerleşimli çekum olan olgulardan birinde terminal ileum Morrison boşluğunda, diğerinde renal hilus anteriorunda yerleşmekteydi. SONUÇ Kolonun yerleşim varyasyonlarının rotasyon ve fiksasyondaki hafif embriyolojik anormallikler, kısa transvers mezokolon, intraperitoneal asendan veya desendan kolon, abdomen içi basınç artışı ve retroperitoneal yağ dokusu miktarının azalması gibi nedenlere bağlı geliştiği düşünülmektedir. Kolonun pankreatikogastrik interpozisyonu %0.2, retrosplenik yerleşimi %0.03-0.3, kısmi retrorenal yerleşim %9-10, tam retrorenal yerleşim %1, böbrek ile psoas kası arasına interpozisyonu sağda %1.7 solda %0.7, anterolateral hepatodiyafragmatik interpozisyon %1.3-3 oranlarında gözlenebilmektedir. Atipik yerleşimli kolon, patolojik olduğunda tanı hatalarına yol açabilir. Küçük omentumda yerleştiğinde patolojik olmasa da, bu bölgenin birçok patolojisinin görünümünü taklit edebilir. İntravenöz ürografi tetkiklerinde kitle imajı yaratabilir. Karaciğer, böbrek, dalak veya safra kesesi perkütan girişimlerinde ve cerrahisinde kolon perforasyonu oluşabilir. Bu nedenlerle BT incelemelerinde kolonun atipik yerleşimleri araştırılmalıdır.PURPOSE: The frequency of anatomic variations of the colon detected on abdominal CT scans was examined. MATERIALS AND METHODS: 296 consequtive abdominal tomography were evaluated prospectively for the presence of retrorenal colon, retrogastric (pancreaticogastric interposition or retrosplenic) colon, high positioned colon, interposition of the colon between the psoas muscle and the kidney and hepatodiaphragmatic interposition (anterior or posterior). RESULTS: We observed 2 retrogastric colon [1 pancreaticogastric (0.3%), 1 retrosplenic (0.3%)], 7 retrorenal colon (1.2%) being bilateral in two cases, 2 interposition of colon between the psoas muscle and the kidney (0.7%), 1 posterior (0.3%) and 6 anterolateral hepatodiaphragmatic interposition (2.1%) and 12 high positioned cecum (4.2%) (in 4 of them cecum was totally subhepatic in location). Terminal ileum was lying in Morrison‘s pouch and anterior to renal hilus in two of the cases with subhepatic cecum. CONCLUSION: Anatomic variations of the colon probably result due to mild embryologic abnormalities of bowel rotation and fixation, short transvers mesocolon, intraperitoneal ascending or descending colon, increased intraperitoneal pressure or decreased retroperitoneal fat. Pancreaticogastric interposition occurs in approximately 0.2%, partial retrorenal colon in 9-10%, complete retrorenal colon 1%, interposition between psoas muscle and kidney in 0.7-1.7%, anterolateral hepatodiaphragmatic interposition in 1.3-3% of individuals. When located in lesser sac it simulates several pathologies of this area. On intravenous urography images it may cause mass effect. In percutaneous interventions and surgical procedures colon may be perforated. For these reasons tomography images should be evaluated for the presence of these anatomic variations

Midbrain–hindbrain involvement in lissencephalies

OBJECTIVES: To determine the involvement of the midbrain and hindbrain (MHB) in the groups of classic (cLIS), variant (vLIS), and cobblestone complex (CBSC) lissencephalies and to determine whether a correlation exists between the cerebral malformation and the MHB abnormalities. METHODS: MRI scans of 111 patients (aged 1 day to 32 years; mean 5 years 4 months) were retrospectively reviewed. After reviewing the brain involvement on MRI, the cases were reclassified according to known mutation (LIS1, DCX, ARX, VLDLR, RELN, MEB, WWS) or mutation phenotype (LIS1-P, DCX-P, RELN-P, ARX-P, VLDLR-P) determined on the basis of characteristic MRI features. Abnormalities in the MHB were then recorded. For each structure, a score was assigned, ranging from 0 (normal) to 3 (severely abnormal). The differences between defined groups and the correlation between the extent of brain agyria/pachygyria and MHB involvement were assessed using Kruskal-Wallis and χ McNemar tests. RESULTS: There was a significant difference in MHB appearance among the three major groups of cLIS, vLIS, and CBSC. The overall score showed a severity gradient of MHB involvement: cLIS (0 or 1), vLIS (7), and CBSC (11 or 12). The extent of cerebral lissencephaly was significantly correlated with the severity of MHB abnormalities (p = 0.0029). CONCLUSION: Our study focused on posterior fossa anomalies, which are an integral part of cobblestone complex lissencephalies but previously have not been well categorized for other lissencephalies. According to our results and the review of the literature, we propose a new classification of human lissencephalies. © 2009 by AAN Enterprises, Inc.SCOPUS: ar.jinfo:eu-repo/semantics/publishe

Dilated perivascular spaces: An informative radiologic finding in Sanfilippo syndrome type A

WOS: 000255340200011PubMed: 18410855Mucopolysaccharidosis type IIIA, or Sanfilippo syndrome type A, is a lysosomal storage disorder caused by deficiency of heparan N-sulfamidase, resulting in defective degradation and subsequent storage of heparan sulfate. It is characterized by progressive nervous system involvement. Cribriform changes in the corpus callosum, basal ganglia, and white matter, diffuse high-intensity signal in the white matter, and cerebral atrophy have been described in patients with this disorder. This case report describes a child with Sanfilippo syndrome type A who exhibited fairly mild clinical findings but-an unusual magnetic resonance imaging pattern that included multiple moderate-sized cysts (probably enlarged perivascular spaces) within the corpus callosum and an abnormal appearance of the clivus and cervical vertebrae. This case calls attention to the variety of appearances possible with magnetic resonance imaging in Sanfilippo syndrome type A. (C) 2008 by Elsevier Inc. All rights reserved

Evaluation of acute trismus by MRI: a case report - Bilateral peritonsillar cellulitis

YAZGAN, HATICE CISEL/0000-0003-2804-7321WOS: 000241796100015PubMed: 16804718We describe a rare case of a bilateral peritonsillar cellulites (PTC). The clinical presentation of fever, trismus and odynophagia was consistent with PTC, more evident on the right side; but the presence of bilateral tonsillar swelling and midline uvula confounded the diagnosis. In spite of the throat examination was performed with a great difficulty due to trismus, the T2 weighted fat saturated STIR magnetic resonance imaging (MRI) guided us to make the diagnosis and to start the intravenous antibiotic treatment immediately

The follow-up of endoscopic sinus surgery's results with computed tomography

Bu çalışmada; endoskopik sinüs cerrahisi (ESC) öncesi ve sonrası bilgisayarlı tomografi (BT) çekilerek cerrahi başarının objektif olarak değerlendirilmesi amaçlanmıştır. Kronik rinosinüzit nedeniyle 1998-2000 yılları arasında ESC yapılan 98 hastadan preoperatif ve postoperatif BT’si çekilebilen 52 hasta çalışmaya dahil edilmiştir. Maksiller ve etmoid hücre patolojilerinde %92 düzelme saptanırken, frontal sinüs patolojilerinde bu oran %27 olarak bulunmuştur. ESC yapılan hastaların postoperatif dönemdeki takiplerinde gerek ameliyatın başarısının değerlendirilmesi gerekse rekürrenslerin erken tanısı için klinik ve endoskopik muayenenin yanında BT kontrolünün de takipte yararlı olacağı kanısındayız.The aim of this study is to evaluate of surgery satisfaction, before and after endoscopic sinus surgery(ESS) with computed tomography(CT). 52 of 98 patients who had chronic rhinosinusitis, could be examined with preoperative and postoperative CT scan, have been added to this project. 92% cure of the pathologic maxiller and etmoid cell diseases was observed, but this ratio was 27% for frontal sinus pathologies. We consider that CT is also useful with clinical and endoscopic diagnosis for whether evaluation of surgery satisfaction or early diagnosis of recurrence in postoperative follow-up of patients with ESS

Cardiac Tamponade as a Life-Threatening Complication of Laparoscopic Antireflux Surgery: The Real Incidence and 3D Anatomy of a Heart Injury by Helical Tacks

Background: Cardiac tamponade (CT) is a dreadful complication of laparoscopic antireflux surgery (LARS) with unknown incidence, and preventive measures are yet to be defined. Incidence during LARS with respect to usage/configuration of graft deployment is analyzed. Three-dimensional (3D) analysis of tack distribution provided anatomical insight to prevent cardiac injury. Materials and Methods: Data regarding the usage and configuration of graft deployment are retrieved from the prospective database. Grafting was posterior or posterior + anterior. Incidence of CT in all hiatoplasties is calculated. Tomography is reconstructed in 3D, showing the spatial distribution of the tacks. Tacks are numbered in the surgical video. Corresponding numbering is applied to the tacks in any particular tomography slice, utilizing the 3D images as an interface. A numbering-blinded radiologist is asked to identify the offending and the nonoffending tacks as the cause of tamponade. Tack-to-pericardium distances are recorded. Tacks having no measurable distance from the pericardium are regarded as offensive. Results: One CT occurred in 1302 consecutive LARS (0.076%). The incidence is 0% when no (379) or posterior (880) graft is used as opposed to 2.3% rate in posterior + anterior (43) grafting. The distribution of offensive, nonoffensive but nearest, and safe tacks followed a pattern. All offensive tacks belonged to the anterior graft fixation, which we referred as the critical zone. Conclusion: CT during LARS is rare, and associated with graft fixation anterior to the hiatal opening. Avoiding graft fixation to the critical zone may prevent cardiac injury

Diagnosis and management of vaginal mullerian cyst in a virgin patient

WOS: 000254751000023PubMed: 18008018Benign cystic lesions of the vagina are uncommon and may become symptomatic. We describe two symptomatic anterior vaginal wall cysts in a virgin patient and the usefulness of imaging modalities. A 36-year-old virgin woman presented with a complaint of vaginal bulging and pelvic pressure. Pelvic examination revealed a cystic mass protruding from the vagina surrounded by the intact hymen. The initial abdominopelvic ultrasound showed a hypoechoic cystic mass measuring 42 x 20 mm in the vagina. She then had a pelvic magnetic resonance imaging (MRI) that revealed two anterior vaginal wall cysts with no communication with the urethra or bladder. The cysts were excised and histologic examination with mucicarmine revealed mucin-secreting tall columnar cells consistent with a diagnosis of mullerian cyst. While both ultrasonographic examination and MRI are helpful in localizing vaginal cysts, MRI is superior in showing multiple cystic lesions of the vagina and their communication with the surrounding structures