Osteochondrosis dissecans of the knee : evaluation of the evolution of MR morphology during treatment

Background: To assess the evolution of MR morphology of OCD lesions in response to treatment and feasibility of MRI as a control study in patients with treated OCD. Material/Methods: 11 patients (6 women and 5 men, aged 11-24 years, average age 17 years) with lesions affecting 12 knee joints were followed for approximately 24.2 months with repeated clinical examination and MR imaging. All MR studies were performed on a 1.5 Tesla unit. MR arthrography was performed in 3 patients. The evolution of MR morphology of the lesions was assessed with a 5-point scale and correlated with the results of clinical assessment with a modified Lysholm scale. Results: In 10 patients, a good clinical result was achieved. In 7 knee joints of patients from this group, the features of the healing of the OCD lesion were observed in MRI and in 4 knees the morphology of the OCD lesion was stable. In 5 MR examinations, a transient deterioration was observed, which in 4 cases preceded healing and in 1 case stabilization in MR morphology. Conclusions: Transient deterioration may be observed in MR studies prior to the healing of OCD lesions irrespective of the improvement in clinical examination. The follow up of patients with OCD should be based mainly on clinical examination, with MR studies reserved for late control or patients with clinical signs of deterioration

Osteoblastoma of the femur in a patient with recurrent paronychia : case report

Background: Osteoblastoma is a rare primary benign bone tumor that has varied radiologic presentation depending on the affected site. In selected cases, differential diagnosis with subacute osteomyelitis is necessary. Case Report: The authors present the case of a 23 year-old male with recurrent paronychia diagnosed with osteoblastoma of the femur. On the basis of CT and MRI findings, osteosarcoma, ABC, enchondroma, chondromyxoid fibroma, and Brodie's abscess were excluded from differential diagnosis, with the last option being the second most probable diagnosis given the coexistence of chronic pyogenic process. Discussion: Plain film findings in osteoblastoma and Brodie's abscess may be strikingly similar with an osteolytic lesion surrounded by prominent sclerosis. The nature of the lesion can be further elucidated by cross-sectional imaging. CT helps to assess the lesion matrix and presence or absence of sequestra or fistulae, while MRI defines the extent of the changes in bone marrow cavity and soft tissues

Is whole-body trauma MDCT justified in patients in good clinical condition but with dangerous trauma mechanism?

Background: To assess whether whole body MDCT is justified in patients in good clinical condition yet with dangerous trauma mechanism. Material/Methods: The study included 81 patients who were examined between January and July 2008 with wholebody trauma CT protocol. Inclusion into the study was based on a dangerous trauma mechanism and the possibility of an unbiased calculation of the weighted revised trauma score (RTSw). All examinations were performed with 16 row MDCT scanner located in emergency department. The cut off of the RTSw over 6.0 was used to separate the patients in good clinical condition. The CT examinations and medical records of patients were reviewed to assess the number of significant injuries, the need for emergency surgery and other types of medical treatment, the number of negative CT examinations, the number of patients admitted to hospital, and mortality. Results: 28 life-threatening injuries were found in 21 of 61 patients with RTS over 6.0 (34.4%). Only two of those patients required emergency surgery (laparotomy). CT studies were negative for traumatic injuries in 22 patients from this group (36.0%). Conclusions: Whole-body MDCT may detect injuries in patients in good clinical condition, with some of them demanding medical treatment. Still, further studies are required to balance the advantages of MDCT and potentially harmful effects of radiation dose, especially better triage systems and lowdose protocols are needed

Hypoglossal nerve palsy as an isolated syndrome of internal carotid artery dissection: A review of the literature and a case report

A review of literature on the dissection of internal carotid artery was presented with apresentation of a rare case of patient with transient left hypoglossal nerve palsy caused bymechanic compression from intramural hematoma in higher extracranial portion of dissected carotid artery confirmed in MRI and CT scans. The clinical presentation and management are discussed

Characterisation and OSL dating of modern fluvial sediments in the lower Vistula River: testing the zeroing assumption

In this study recent sediments of the lower Vistula River were investigated to determine the relationship between the structure and texture specific features and the possibility of their zeroing. The samples of recent fluvial deposits were collected from the lower Vistula River at two sites in Toruń and Ciechocinek. Sand bars newly emerged from the river were selected for testing. The coarse quartz grains were separated for OSL measurements. The single-aliquot regenerative (SAR) technique was applied for measuring equivalent doses from multigrain aliquots. The obtained dose estimates were found to be very low, proving the reliability of OSL zeroing assumption. The dose rates were estimated by gamma-ray spectrometry, demonstrating homogeneity of the radiation field. These results related to fossil sediments of that type confirm their suitability for the OSL dating method

The value of ultrasonography in the diagnosis of varicocele

A varicocele is described as pathologically enlarged, tortuous veins of the pampiniform plexus, leading to an increased testicular temperature and adrenal metabolite reflux into the testes. Varicocele can impair spermatogenesis and is considered to be the most common cause of male infertility. Patients may palpate a thickening in the scrotum or complain of dull scrotal or inguinal pain, which increases when standing or during erection. In the case of a sudden onset of varicocele in elderly men, it is necessary to exclude renal tumor and extend diagnostic ultrasound with the assessment of the abdominal cavity. The diagnosis of varicocele is based on medical history and physical examination, which involves palpation and observation of the scrotum at rest and during the Valsalva maneuver. Ultrasound is the imaging method of choice. The width and the number of vessels in the pampiniform plexus as well as the evaluation and measurement of regurgitation during the Valsalva maneuver are typical parameters analyzed during ultrasound assessment. However, diagnostic ultrasound is still a controversial method due to numerous and often divergent classification systems for varicocele assessment as well as its poor correlation with clinical manifestations. As a result of introduction of clear ultrasound criteria as well as the development of elastography and nuclear magnetic resonance, diagnostic imaging can play an important role in assessing the risk of damage to the testicular parenchyma, qualifying patients for surgical treatment and predicting the effects of therapy

A deceptive case of emphysematous cholecystitis complicated with retroperitoneal gangrene and emphysematous pancreatitis : clinical and computed tomography features

Purpose: Emphysematous cholecystitis (EC) is an uncommon, severe variant of acute cholecystitis caused by gasforming bacteria - most often Clostridium perfringens and Escherichia coli. We present a deceptive case of EC associated with retroperitoneal gas gangrene and emphysematous pancreatitis. Case report: An 86-year-old, overweight woman was admitted to the emergency department with non-specific abdominal symptoms. Admission laboratory tests showed elevated diastase levels indicating acute pancreatitis. Computed tomography (CT) demonstrated a substantial amount of gas in the retroperitoneum and peritoneal cavity, which raised a suspicion of duodenal perforation. Primary diagnosis was not confirmed during emergency laparotomy, which revealed a gangrenous gallbladder adjacent to the duodenum and surrounded by purulent fluid. The final diagnosis established after laparotomy and rereading of CT scans was that of emphysematous cholecystitis associated with gangrenous pancreatitis and retroperitoneal gangrene. After surgery, the patient was transferred to the intensive care unit in septic shock. Shortly after, the second laparotomy was undertaken on suspicion of internal bleeding. During surgery, the patient experienced cardiac arrest and died despite immediate resuscitation. Conclusions: Emphysematous cholecystitis may be associated with a spread of infection both to the peritoneal cavity and retroperitoneum and result in a substantial amount of gas in those anatomic compartments. The knowledge of this rare complication may be helpful in establishing a correct diagnosis

Peak systolic velocity of tricuspid annulus is inferior to tricuspid annular plane systolic excursion for 30 days prediction of adverse outcome in acute pulmonary embolism

Background: Tricuspid annular plane systolic excursion (TAPSE) is an established index of right ventricular (RV) systolic function and a significant predictor in normotensive patients with pulmonary embolism (PE). Recently, Doppler tissue imaging-derived tricuspid annular systolic velocity (TV S’), a modern parameter of RV function was reported to be useful in the diagnosis and prognosis of a broad spectrum of heart diseases. Therefore, herein, is an analysis of the prognostic value of both parameters in normotensive PE patients.Methods: One hundred and thirty nine consecutive PE patients (76 female, age 56.4 ± 19.5 years) were included in this study. All patients were initially anticoagulated. Transthoracic echocardiography was performed on admission. The study endpoint (SE) was defined as PE-related 30-day mortality and/or need for rescue thrombolysis.Results: Seven (5%) patients who met the criteria for SE presented more severe RV dysfunction at echocardiography. Univariable Cox regression analysis showed that RV/LV ratio predicted SE with hazard risk (HR) 10.6 (1.4–80.0; p = 0.02); TAPSE and TV S’ showed HR 0.77 (0.67–0.89), p < 0.001, and 0.71 (0.52–0.97), p = 0.03, respectively. Area under the curve for TAPSE in the prediction of SE was 0.881; 95% CI 0.812–0.932, p = 0.0001, for TV S’ was 0.751; 95% CI 0.670–0.820, p = 0.001. Multivariable analysis showed that the optimal prediction model included TAPSE and systolic blood pressure (SBP showed HR 0.89 95% CI 0.83–0.95, p < 0.001 and TAPSE HR 0.67, 95% CI 0.52–0.87, p<0.03). Kaplan-Meier analysis showed that initially PE patients with TAPSE ≥ 18 mm had a much more favorable prognosis that patients with TAPSE < 18 mm (p < 0.01), while analysis of S’ was only of borderline statistical significance.Conclusions: It seems that TV S’ is inferior to TAPSE for 30 day prediction of adverse outcome in acute pulmonary embolism

Ocena przebiegu klinicznego u chorych z ostrą zatorowością płucną i skrzeplinami w jamach prawego serca. Doświadczenia jednego ośrodka

Introduction. Assessment of the clinical course of patients with acute pulmonary embolism (PE) and a right heart thrombus (RiHT). Material and methods. The analysis included 13 consecutive patients with echocardiographically detected RiHT and acute PE who were treated in our department. The endpoints were 30-day all-cause mortality and 30-day acute PE-related mortality. When a clear alternative cause of death was reported, a non-acute PE-related death was diagnosed and this contributed to 30-day all-cause mortality. All other fatalities were classified as related to acute PE. Results. High risk acute PE was diagnosed in 4 of 13 patients, and intermediate risk acute PE was diagnosed in the remaining 9 patients. Thrombolysis was the first-choice treatment in 4 (31%) patients, 6 (46%) patients were only anticoagulated, and the remaining 3 (23%) patients underwent surgical treatment. The main indication for embolectomy was RiHT entrapped in a patent foramen ovale (PFO). Two patients died during the first 30 days; they were hemodynamically unstable and deaths occurred within 48 hours since the diagnosis. No hemodynamically stable patients died within 30 days since the diagnosis. Conclusions. Thirty-day mortality in patients with RiHT depended mostly on the patient’s clinical condition and was not related to the presence or morphology of the thrombus. Patients with shock or hypotension may possibly benefit more from primary invasive treatment compared to drug therapy.Wstęp. Ocena przebiegu klinicznego chorych z ostrą zatorowością płucną (PE) i skrzeplinami w jamach prawej części serca (RiHT) diagnozowanych i leczonych w jednym ośrodku. Materiał i metody. Analizą objęto kolejnych 13 chorych ze stwierdzoną echokardiograficznie RiHT i ostrą PE leczonych w klinice autorów. Punktem końcowym była 30-dniowa śmiertelność całkowita oraz zależna od ostrej PE. Zgony niezwiązane z ostrą PE rozpoznawano, jeżeli występowały inne jednoznaczne przyczyny. W innych sytuacjach zgony zakwalifikowano jako związane z ostrą PE. Wyniki. U 4 spośród 13 chorych z ostrą PE i RiHT rozpoznano ostrą PE wysokiego ryzyka, u pozostałych 9 osób rozpoznano ostrą PE pośredniego ryzyka. Jako leczenie pierwszego wyboru trombolizę zastosowano u 4 (31%) chorych, wyłączne leczenie przeciwzakrzepowe wybrano u 6 (46%) osób, natomiast zabieg kardiochirurgiczny przeprowadzono u 3 (23%) chorych z RiHT i ostrą PE — wskazaniem do jego wykonania była skrzeplina wklinowana w drożny otwór owalny (PFO). W ciągu 30 dni zmarło 2 chorych (15%) — były to osoby niestabilne hemodynamicznie. W ciągu 30 dni od rozpoznania nie zmarł nikt spośród chorych w stanie stabilnym, a większość zgonów nastąpiła w trakcie pierwszych 48 h hospitalizacji. Wnioski. Śmiertelność 30-dniowa u chorych z RiHT zależy głównie od stanu klinicznego. Osoby z niedociśnieniem lub wstrząsem mogą odnieść większą korzyść z pierwotnego leczenia inwazyjnego niż z leczenia farmakologicznego

Differentiation of focal hepatic lesions in MR imaging with the use of combined quantitative and qualitative analysis

Background: To evaluate the efficacy of the protocol of combined quantitative-qualitative analysis for the differentiation of focal hepatic lesions. Material/Methods: The study group included 168 patients with 292 hepatic lesions confirmed by histology (n =138) or follow-up (n =154). Lesions were divided into: benign lesions treated conservatively (group A, 120 lesions), malignant tumors and benign lesions treated surgically (group B, 172 lesions). MR imaging (1.5-T) consisted of sequences: T2 double-echo TSE, T2 STIR, T1 GRE and of dynamic study. During the first part of differentiation process, quantitative analysis, based on lesions T2 relaxation times (derived from T2 double-echo TSE sequence), was performed in order to discriminate non-solid lesions (hemangiomas, cysts, abscesses; n = 88) from solid tumors (n = 204). Subsequently, all tumors defined as solid underwent qualitative evaluation based on visual assessment of lesions signal intensities in all sequences and patterns of their contrast enhancement. The aim of this part of analysis was to discriminate benign lesions (FNH and focal fatty infiltration) from other solid tumors. The remaining tumors were characterized as group B lesions. Results: Statistically significant difference between mean T2 relaxation time of solid tumors (84.1 ms) and non-solid lesions (250.5 ms) was noted, allowing diagnosis of solid tumors with sensitivity of 96% and specificity of 93% (at the threshold of 116 ms). Overall 202 lesions were defined as solid (196 true positive, 8 false negative, 6 false positive results). Qualitative analysis of these lesions was performed allowing correct characterization of all 7 focal fatty infiltrations and 21 of 24 FNH. Six lesions were falsely diagnosed as FNH. Remaining 168 lesions were defined as group B lesions. Both parts of differentiation protocol yielded sensitivity and specificity of 92%, allowing correct characterization of 158 of 172 group B lesions. Fourteen false negative and 10 false positive results (3 FNH, 1 focal inflammation, 6 hemangiomas) were obtained. Conclusions: Combined protocol of quantitative and qualitative analysis enabled discrimination of group B lesions (malignant tumors and benign lesions treated surgically) with high sensitivity and specificity of 92%