Role of Magnetic Resonance Imaging in the Diagnosis of Osteomyelitis in Diabetic Foot Infections.

PURPOSE: The role of magnetic resonance imaging (MRI) in the diagnosis of osteomyelitis in foot infections in diabetics was investigated. The accuracy, sensitivity, and specificity of MRI, plain radiography, and nuclear scanning were determined for diagnosing osteomyelitis, and a cost comparison was made. METHODS: Twenty-seven patients with diabetic foot infections were studied prospectively. All patients underwent MRI and plain radiography. Twenty-two patients had technetium bone scans, and 19 patients had Indium scans. Nineteen patients had all four tests performed. Patients with obvious gangrene or a fetid foot were excluded. RESULTS: The diagnosis of osteomyelitis was established by pathologic specimen (n = 18), bone culture (n = 3), or successful response to medical management (n = 6). Osteomyelitis was confirmed in nine of the pathologic specimens. The diagnostic sensitivity, specificity, and accuracy for MRI was 88%, 100%, and 95%, respectively, for plain radiography it was 22%, 94%, and 70%, respectively, for technetium bone scanning it was 50%, 50%, and 50%, respectively, and for Indium leukocyte scanning it was 33%, 69%, and 58%, respectively. The data were analyzed statistically with the two-tailed Fisher\u27s exact test. MRI was the only test that was statistically significant (p \u3c 0.01). CONCLUSIONS: MRI appeared to be the single best test for the diagnosis of osteomyelitis associated with diabetic foot infections. It had a better diagnostic accuracy than conventional modalities and appeared to be more cost-effective than the frequently used Indium scan

Situs Inversus Totalis and an Infrarenal Abdominal Aortic Aneurysm: Case Report.

Situs inversus totalis is a rare clinical finding. A patient with a 7 cm in frarenal abdominal aortic aneurysm and situs inversus totalis is presented. The patient underwent routine and uneventful operative management of his aneu rysm. This case demonstrates the relative ease of aneurysm resection in this setting if the anomaly is recognized preoperatively

Marfan\u27s Syndrome and Abdominal Aortic Aneurysm— A Case Report.

This patient\u27s course documents the successful repair of an abdominal aor tic aneurysm in a sixty-two-year-old man with Marfan\u27s syndrome. Marfan\u27s syndrome, a connective tissue disorder, is commonly associated with cardiovas cular complications, including ascending aortic aneurysms and dissecting aneurysms of the thoracic aorta with aortic insufficiency. Abdominal aortic aneurysms, are, however, rare. Although this procedure can be hazardous in patients with Marfan\u27s syndrome, the authors encountered no significant com plications with their patient, who was doing well twenty-one months postopera tively

Gastroesophageal Tumor Embolization to the Popliteal Arteries.

Arterial tumor embolization is an unusual cause of acute arterial occlusion and is reported primarily in the oncologic literature. We report a case of acute bilateral popliteal artery emboli from adenocarcinoma of the distal esophagus. Arterial tumor emboli are infrequent but should be considered in the differential diagnosis by the vascular surgeon caring for patients with malignancy

The Cerebral Hyperperfusion Syndrome: Diagnostic Value of Ocular Pneumoplethysmography.

PURPOSE: There were two purposes to our study. The first was to characterize the ocular hyperperfusion associated with carotid endarterectomy. The second was to relate ocular hyperperfusion to the clinical presentation of cerebral hyperperfusion syndrome. METHODS: This was a retrospective chart review of 2331 patients who underwent carotid endarterectomy at our institution between June 1978 and May 1991. RESULTS: Twelve of these carotid endarterectomies were associated with ocular hyperperfusion on the side of operation. Clinical evidence of cerebral hyperperfusion syndrome was observed in five of these 12 procedures. In these five patients there were two associated fatal intracerebral hemorrhages and one permanent coma. In the latter three patients the contralateral internal carotid arteries were totally occluded. CONCLUSION: Ocular hyperperfusion, as documented with ocular pneumoplethysmography, is useful in alerting the physician to the potential for development of the cerebral hyperperfusion syndrome

Duplex Ultrasound and Ocular Pneumoplethysmography Concordance in Detecting Severe Carotid Stenosis.

Concordance between two independent tests should serve to increase the accuracy of diagnosis. A combination of ocular pneumoplethysmography and duplex ultrasound, which uses high-resolution B-mode imaging plus spectral analysis, was used to evaluate 289 consecutive patients prior to biplane carotid angiography. Where there was concordance, the noninvasive tests predicted the presence or absence of hemodynamically severe carotid stenosis (75% or greater cross-sectional area reduction) with a sensitivity of 96.8%, a specificity of 95.9%, an accuracy of 96.2%, and positive and negative predictive values of 91.0% and 98.6%, respectively. Of the 538 study arteries, only four (0.74%) angiographically severe lesions escaped detection by both noninvasive tests. Sources of diagnostic error for both tests were defined. We believe that the combination of duplex ultrasound and ocular pneumoplethysmography significantly improves the overall assessment of carotid atherosclerosis

The risk of carotid endarterectomy in patients with chronic renal insufficiency.

OBJECTIVE: Carotid endarterectomy (CEA) has been associated with less favorable outcome in patients with chronic renal insufficiency (CRI). The authors compared results of CEA in the presence and absence of CRI at their institution over a 5-year period. DESIGN/SETTING/PARTICIPANTS: This article is a retrospective review of 1351 patients who underwent CEA between 1998 and 2004. Chronic renal insufficiency was present in 143 patients. Renal insufficiency was graded as mild (creatinine 1.6-2.9 mg/dL) or severe (creatinine \u3e or = 3.0 mg/dL or on hemodialysis). The composite endpoint was stroke or death within 30 days postoperatively. The results were compared with 150 consecutive patients having CEA in the absence of renal insufficiency between 2002 and 2003. RESULTS: For the 143 patients with CRI, the composite endpoint was 9.0%, whereas the composite endpoint for the 150 control patients without CRI was 2.6% (p = 0.032). For patients with severe CRI (creatinine \u3e or = 3.0 or on hemodialysis), the composite endpoint was 19.0% (p = 0.08). For those with mild CRI (creatinine 1.6-2.9), the composite endpoint was 7.3% (p = 0.06). CONCLUSIONS: Chronic renal insufficiency is associated with increased incidence of stroke, myocardial infarction, and death after CEA. For patients with advanced CRI, carotid artery stenting (CAS) or aggressive medical management may be alternative treatment options

Transvenous Rescue of a Kimray-Greenfield Filter from the Right Atrium.

The complications of transvenous interruption of the inferior vena cava are most commonly associated with premature discharge of the device or inadvertent placement at a site other than the preselected position which is most commonly the infrarenal vena cava. This case report illustrates a useful technique for the transvenous retrieval of a partially ejected Kimray-Greenfield filter that became lodged in the right atrium. This simple technique may save the need for open thoracotomy to retrieve the misplaced filter