85 research outputs found
Developmental venous anomalies: appearance on whole-brain CT digital subtraction angiography and CT perfusion
Intensive care of the cancer patient: recent achievements and remaining challenges
A few decades have passed since intensive care unit (ICU) beds have been available for critically ill patients with cancer. Although the initial reports showed dismal prognosis, recent data suggest that an increased number of patients with solid and hematological malignancies benefit from intensive care support, with dramatically decreased mortality rates. Advances in the management of the underlying malignancies and support of organ dysfunctions have led to survival gains in patients with life-threatening complications from the malignancy itself, as well as infectious and toxic adverse effects related to the oncological treatments. In this review, we will appraise the prognostic factors and discuss the overall perspective related to the management of critically ill patients with cancer. The prognostic significance of certain factors has changed over time. For example, neutropenia or autologous bone marrow transplantation (BMT) have less adverse prognostic implications than two decades ago. Similarly, because hematologists and oncologists select patients for ICU admission based on the characteristics of the malignancy, the underlying malignancy rarely influences short-term survival after ICU admission. Since the recent data do not clearly support the benefit of ICU support to unselected critically ill allogeneic BMT recipients, more outcome research is needed in this subgroup. Because of the overall increased survival that has been reported in critically ill patients with cancer, we outline an easy-to-use and evidence-based ICU admission triage criteria that may help avoid depriving life support to patients with cancer who can benefit. Lastly, we propose a research agenda to address unanswered questions
Designing phase 3 sepsis trials: application of learned experiences from critical care trials in acute heart failure
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A retained neurointerventional microcatheter fragment in the anterior communicating artery aneurysm in multi-slice computed tomography angiography
We present a case of multi-slice computed tomography angiography of a 60-year-old patient with a retained fragment of microcatheter within an anterior communicating artery (AcomA) aneurysm. This is a rare complication of Guglielmi detachable coil embolization. After an unsuccessful embolization procedure, the patient underwent surgery. During clipping of an AcomA aneurysm, the microcatheter traveled up the pericallosal branch of the right anterior cerebral artery. Subsequently, the microcatheter fragment did not prevent normal blood flow through the artery, and the patient has been doing well without neurological sequelae
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Multi‐slice computed tomography angiography in the detection of residual or recurrent cerebral aneurysms after surgical clipping
Purpose: To assess the diagnostic accuracy of multi‐slice computed tomography (MSCT) angiography compared to digital subtraction angiography (DSA) in detecting residual or recurrent aneurysms in patients undergoing aneurysm clipping surgery.
Material and Methods: Eight patients with nine aneurysms who had both MSCTA and DSA were included in the study. Two independent experienced neuroradiologists evaluated the examinations.
Results: Accuracy, sensitivity, and specificity of detecting residual or recurrent aneurysms on MSCTA were 0.80, 0.60, and 1.00, respectively. Positive and negative predictive values were 1.00 and 0.71, respectively.
Conclusion: MSCTA is a promising technique for evaluating residual or recurrent aneurysms in patients undergoing surgical treatment of aneurysm with titanium clips
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Acute CT perfusion changes in seizure patients presenting to the emergency department with stroke-like symptoms: correlation with clinical and electroencephalography findings
AIM: To determine acute computed tomography perfusion (CTP) changes in seizure patients presenting with stroke-like symptoms and to correlate those changes with clinical presentation and electroencephalography (EEG).
MATERIALS AND METHODS: The medical records of all patients who presented to the emergency department with acute stroke-like symptoms and underwent CTP (n = 1085) over a 5.5-year period were reviewed. Patients were included who had primary seizure as the final diagnosis, and underwent CTP within 3 hours of symptom onset. A subset of patients had a follow-up EEG within 7 days. The perfusion changes and EEG findings were compared between different clinical presentations.
RESULTS: Eighteen of 1085 patients (1.7%) who underwent CTP following an acute stroke-like presentation were included. The abnormality on CTP was usually focal, unilateral hyper-perfusion - increased relative cerebral blood flow (rCBF) and volume (rCBV) (n = 14/18), which most often affected the temporal lobe. Those patients who presented with a motor or speech deficit (n = 12) had a higher temporal lobe rCBV, and rCBF, and lower relative mean transit time (rMTT) compared to those with non-focal neurological deficit at presentation. Early EEG was available in 13 patients; a sharp-spike epileptiform EEG discharge pattern (n = 5) was associated with higher temporal lobe ipsilateral rCBF and rCBV, and lower rMTT on admission CTP examination.
CONCLUSION: Seizure patients who present with a unilateral motor or speech deficit most commonly have contralateral hyperperfusion in the corresponding eloquent brain regions on the acute-stage CTP examination. In such patients, epileptiform discharges on the early followup EEG are associated with ipsilateral hyperperfusion on the admission CTP. (C) 2015 The Royal College of Radiologists. Published by Elsevier Ltd. All rights reserved
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Detection of aneurysms by 64-section multidetector CT angiography in patients acutely suspected of having an intracranial aneurysm and comparison with digital subtraction and 3D rotational angiography
BACKGROUND AND PURPOSE: Four-section multisection CT angiography (MSCTA) accurately detects aneurysms at or more than 4 mm but is less accurate for those less than 4 mm. Our purpose was to determine the accuracy of 64-section MSCTA (64MSCTA) in aneurysm detection versus combined digital subtraction angiography (DSA) and 3D rotational angiography (3DRA).
MATERIALS AND METHODS: In a retrospective review of patients studied because of acute symptoms suspicious for arising from an intracranial aneurysm, 63 subjects were included who had undergone CT angiography (CTA). Of these, 36 underwent catheter DSA; all but 4 were also studied with 3DRA. The most common indication was subarachnoid hemorrhage (SAH; n = 43). Two neuroradiologists independently reviewed each CIA, IDSA, and 3DRA.
RESULTS: A total of 41 aneurysms were found in 28 patients. The mean size was 6.09 mm on DSA/3DRA and 5.98 mm on 64MSCTA. K was excellent (0.97) between the aneurysm size on 64MSCTA and DSA/3DRA. Ultimately, 37 aneurysms were detected by DSA/3DRA in 25 of the 36 patients who underwent conventional angiography. The reviewers noted four 1- to 1.5-mm sessile outpouchings only on 3DRA; none were considered a source of SAH. One 64MSCTA was false positive, whereas one 2-mrn aneurysm was missed by CTA. The sensitivity of CTA for aneurysms less than 4 mm was 92.3%, whereas it was 100% for those 4-10 mm and more than 10 mm, excluding the indeterminate, sessile lesions.
CONCLUSIONS: In comparison with the available literature, 64MSCTA may have improved the detection of less than 4-mm aneurysms compared with 4- or 16-section CTA. However, the combination of IDSA with 3DRA is currently the most sensitive technique to detect untreated aneurysms and should be considered in suspicious cases of SAH where the aneurysm is not depicted by 64MSCTA, because 64MSCTA may occasionally miss aneurysms less than 3-4 mm size
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Reversible findings of restricted diffusion in 5-flourouracil neurotoxicity
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