Vertebral artery triplication

Abstract

Purpose

To report an extremely rare vertebral artery (VA) origin configuration.

Methods

Angiographic and MRI features of a VA triplication in a child are presented.

Results

The VA trifurcation was the result of the simultaneous persistence of the 4th, 5th and 6th primitive cervical intersegmental arteries, respectively, reaching the transverse canal at C4, C5 and C6. A contralateral VA duplication was noted as well.

Conclusion

A previously undocumented instance of VA triplication is presented. Knowledge of such variations is important for the planning of diagnostic and therapeutic cervicocranial angiography and the understanding of unusual images on noninvasive imaging studies. This type of anomaly also represents a risk factor for arterial dissection.

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Comparison of multi-shot and single shot echo-planar diffusion tensor techniques for the optic pathway in patients with neurofibromatosis type 1

Abstract

Purpose

Diffusion tensor imaging (DTI) may be helpful in assessing optic pathway integrity as a marker for treatment in neurofibromatosis type 1 (NF1) patients with optic gliomas (OG). However, susceptibility artifacts are common in typical single-shot echo planar imaging (ssDTI). A readout-segmented multi-shot EPI technique (rsDTI) was utilized to minimize susceptibility distortions of the skull base and improve quantitative metrics.

Methods

Healthy controls, children with NF1 without OG, and NF1 with OG ± visual symptoms were included. All subjects were scanned with both rsDTI and ssDTI sequences sequentially. Diffusion metrics and deterministic fiber tracking were calculated. Tract count, volume, and length were also compared by a two-factor mixed ANOVA.

Results

Five healthy controls, 7 NF1 children without OG, and 12 NF1 children with OG were imaged. Six OG patients had visual symptoms. Four subjects had no detectable optic pathway fibers on ssDTI due to susceptibility, for which rsDTI was able to delineate. Tract count (p < 0.001), tract volume (p < 0.001), and FA (P < 0.001) were significantly higher for rsDTI versus ssDTI for all subjects. MD (p < 0.001) and RD (p < 0.001) were significantly lower for rsDTI vs ssDTI. Finally, MD, AD, and RD had a significantly lower difference in NF1 children with visual symptoms compared to NF1 children without visual symptoms only on ssDTI scans.

Conclusion

DTI with readout-segmented multi-shot EPI technique can better visualize the optic pathway and allow more confident measurements of anisotropy in NF1 patients. This is shown by a significant increase in FA, tract count, and volume with rsDTI versus ssDTI.

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Issue Information

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Vertebral artery triplication

Abstract

Purpose

To report an extremely rare vertebral artery (VA) origin configuration.

Methods

Angiographic and MRI features of a VA triplication in a child are presented.

Results

The VA trifurcation was the result of the simultaneous persistence of the 4th, 5th and 6th primitive cervical intersegmental arteries, respectively, reaching the transverse canal at C4, C5 and C6. A contralateral VA duplication was noted as well.

Conclusion

A previously undocumented instance of VA triplication is presented. Knowledge of such variations is important for the planning of diagnostic and therapeutic cervicocranial angiography and the understanding of unusual images on noninvasive imaging studies. This type of anomaly also represents a risk factor for arterial dissection.

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Comparison of multi-shot and single shot echo-planar diffusion tensor techniques for the optic pathway in patients with neurofibromatosis type 1

Abstract

Purpose

Diffusion tensor imaging (DTI) may be helpful in assessing optic pathway integrity as a marker for treatment in neurofibromatosis type 1 (NF1) patients with optic gliomas (OG). However, susceptibility artifacts are common in typical single-shot echo planar imaging (ssDTI). A readout-segmented multi-shot EPI technique (rsDTI) was utilized to minimize susceptibility distortions of the skull base and improve quantitative metrics.

Methods

Healthy controls, children with NF1 without OG, and NF1 with OG ± visual symptoms were included. All subjects were scanned with both rsDTI and ssDTI sequences sequentially. Diffusion metrics and deterministic fiber tracking were calculated. Tract count, volume, and length were also compared by a two-factor mixed ANOVA.

Results

Five healthy controls, 7 NF1 children without OG, and 12 NF1 children with OG were imaged. Six OG patients had visual symptoms. Four subjects had no detectable optic pathway fibers on ssDTI due to susceptibility, for which rsDTI was able to delineate. Tract count (p < 0.001), tract volume (p < 0.001), and FA (P < 0.001) were significantly higher for rsDTI versus ssDTI for all subjects. MD (p < 0.001) and RD (p < 0.001) were significantly lower for rsDTI vs ssDTI. Finally, MD, AD, and RD had a significantly lower difference in NF1 children with visual symptoms compared to NF1 children without visual symptoms only on ssDTI scans.

Conclusion

DTI with readout-segmented multi-shot EPI technique can better visualize the optic pathway and allow more confident measurements of anisotropy in NF1 patients. This is shown by a significant increase in FA, tract count, and volume with rsDTI versus ssDTI.

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Issue Information

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Correction to: Pediatric ileocolic intussusception: new observations and unexpected implications

In this article, the fourth author's name is misspelled. The correct spelling, as shown above, should be "Nadia F. Mahmood."

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Correction to: Pediatric ileocolic intussusception: new observations and unexpected implications

In this article, the fourth author's name is misspelled. The correct spelling, as shown above, should be "Nadia F. Mahmood."

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Cutaneous involvement as the first manifestation of T‐lymphoblastic lymphoma and review of the literature.

Lymphoblastic lymphomas (LBL) are uncommon malignant neoplasms derived from immature T‐ or B‐ lymphoid progenitor cells. Although cutaneous involvement may reach 33% in B‐LBL, only twelve cutaneous cases of T‐ LBL have been published. We report the case of a 49‐year‐old woman with 2‐month history of erythematous‐violaceous plaques in the sternal region and breasts. Histopathologic examination showed a dense monomorphus infiltrate in dermis and positive immunostainings for CD3, CD99 and terminal deoxynucleotidyl transferase, thus indicating T‐LBL. Staging work‐up only revealed a mediastinal mass at diagnosis. After a 51‐month follow‐up and different treatment regimens, the patient remains alive although she has presented four relapses, all of them extramedullary.

This article is protected by copyright. All rights reserved.

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Cutaneous involvement as the first manifestation of T‐lymphoblastic lymphoma and review of the literature.

Lymphoblastic lymphomas (LBL) are uncommon malignant neoplasms derived from immature T‐ or B‐ lymphoid progenitor cells. Although cutaneous involvement may reach 33% in B‐LBL, only twelve cutaneous cases of T‐ LBL have been published. We report the case of a 49‐year‐old woman with 2‐month history of erythematous‐violaceous plaques in the sternal region and breasts. Histopathologic examination showed a dense monomorphus infiltrate in dermis and positive immunostainings for CD3, CD99 and terminal deoxynucleotidyl transferase, thus indicating T‐LBL. Staging work‐up only revealed a mediastinal mass at diagnosis. After a 51‐month follow‐up and different treatment regimens, the patient remains alive although she has presented four relapses, all of them extramedullary.

This article is protected by copyright. All rights reserved.

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Editorial Board

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Editorial Board

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Acute Toxic Leukoencephalopathy: Etiologies, Imaging Findings, and Outcomes in 101 Patients [ADULT BRAIN]

BACKGROUND AND PURPOSE:

Prior studies regarding acute toxic leukoencephalopathy (ATL) are either small, or preliminary. Our aim was to evaluate etiologies of and differences in imaging severity and outcomes among various etiologies of ATL.

MATERIALS AND METHODS:

MRIs of patients with suspected ATL over 15 years were retrospectively reviewed; inclusion criteria were: MRI <3 weeks of presentation with both DWI and FLAIR. These were jointly graded by two neuroradiologists via a previously described score of severity. Clinical outcome was evaluated via both modified Rankin (mRS) and ATL outcome (ATLOS) scores, each being correlated with the DWI and FLAIR scores. Etiologic subgroups of n > 6 patients were statistically compared.

RESULTS:

Of 101 included patients, the 4 subgroups of n > 6 were the following: chemotherapy (n = 35), opiates (n = 19), acute hepatic encephalopathy (n = 14), and immunosuppressants (n = 11). Other causes (n = 22 total) notably included carbon monoxide (n = 3) metronidazole (n = 2), and uremia (n = 1). The mean DWI/FLAIR severity scores were 2.6/2.3, 3.3/3.3, 2.1/2.1 and 2.0/2.5 for chemotherapeutics, opiates, AHE and immunosuppressants, respectively, with significant differences in both imaging severity and outcome (P = .003–.032) among subgroups, particularly immunosuppressant versus chemotherapy-related ATL and immunosuppressants versus opiates (P = .004–.032) related ATL. DWI and FLAIR severity weakly correlated with outcome ( = 0.289–.349, P < .005) but correlated stronger in the chemotherapy ( = 0.460–.586, P < .010) and opiate ( =.472–.608, P < .05) subgroups, which had the worst outcomes. ATL clinically resolved in 36%, with severe outcomes in 23% (coma or death, 9/16 deaths from fludarabine). Notable laboratory results were elevated CSF myelin basic protein levels in 8/9 patients and serum blood urea nitrogen levels in 24/91.

CONCLUSIONS:

Clinical outcomes of ATL vary on the basis of etiology, being worse in chemotherapeutic- and opiate-related ATL. Uremia may be a predisposing or exacerbating factor.

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A 3T Phase-Sensitive Inversion Recovery MRI Sequence Improves Detection of Cervical Spinal Cord Lesions and Shows Active Lesions in Patients with Multiple Sclerosis [SPINE]

BACKGROUND AND PURPOSE:

Magnetic Resonance Imaging is the modality of choice to detect spinal cord lesions in patients with Multiple Sclerosis (MS). However, this imaging is challenging. New sequences such as phase-sensitive inversion recovery have been developed to improve detection. Our aim was to compare a 3D phase-sensitive inversion recovery and a conventional imaging dataset including postcontrast T2WI and T1WI to detect MS spinal cord lesions.

MATERIALS AND METHODS:

This retrospective single-center study included 100 consecutive patients with MS (mean age, 41 years) from January 2015 to June 2016. One senior neuroradiologist and 1 junior radiologist blinded to clinical data checked for new spinal cord lesions, individually analyzing conventional and 3D phase-sensitive inversion recovery datasets separately, placing a 3-week delay between the 2 readings. A consensus reading was done with a third senior neuroradiologist. A Wilcoxon test was used to compare the 2 imaging datasets. Intra- and interobserver agreement was assessed by the coefficient.

RESULTS:

3D phase-sensitive inversion recovery detected significantly more lesions than conventional imaging (480 versus 168, P < .001). Eleven patients had no detected lesions on T2WI, whereas 3D phase-sensitive inversion recovery detected at least 1 lesion. All postcontrast T1WI enhancing lesions were also visible on 3D phase-sensitive inversion recovery. The signal-to-noise ratio was significantly higher using 3D phase-sensitive inversion recovery (0.63 versus 0.46, P = .03). Mean reading confidence was significantly higher using 3D phase-sensitive inversion recovery. Inter- and intraobserver agreement was good for both datasets.

CONCLUSIONS:

Our study showed that 3D phase-sensitive inversion recovery significantly improved detection of cervical spinal cord lesions, including both enhancing and nonenhancing lesions in patients with MS.

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Risk of Acute Kidney Injury with Consecutive, Multidose Use of Iodinated Contrast in Patients with Acute Ischemic Stroke [ADULT BRAIN]

SUMMARY:

Currently, CTA is the imaging technique most frequently used to evaluate acute ischemic stroke, and patients with intracranial large-vessel occlusion usually undergo endovascular treatment. This single-center, prospective, cohort study showed that consecutive, multidose use of contrast during CTA and DSA does not increase the incidence of acute kidney injury in patients with acute ischemic stroke, though acute kidney injury tended to have a higher incidence in the contrast multiexposure group (P = .172).

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Validating the Automatic Independent Component Analysis of DSA [INTERVENTIONAL]

SUMMARY:

Time-density curve analysis of DSA provides useful blood flow information. However, manually selecting the ROI is time-consuming. We developed an automatic technique to provide arterial, capillary, and venous vasculatures with corresponding time-density curves. This study retrospectively analyzed the data of 36 patients with unilateral carotid stenosis. We found that the full width at half maximum of the time-density curve for the automatically segmented capillary vasculature is a suitable representation of the cerebral circulation time.

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High-Resolution Vessel Wall MR Imaging as an Alternative to Brain Biopsy [LETTERS]

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The "Bovine Aortic Arch": Time to Rethink the True Origin of the Term? [LETTERS]

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Ostium Ratio and Neck Ratio Could Predict the Outcome of Sidewall Intracranial Aneurysms Treated with Flow Diverters [INTERVENTIONAL]

BACKGROUND AND PURPOSE:

Incompletely occluded flow diverter treated aneurysms remain at risk of rupture and thromboembolic complications. Our aim was to identify the potential for incomplete occlusion of intracranial aneurysms treated by flow diverters. We investigated whether aneurysm ostium size in relation to parent artery size affects angiographic outcomes of flow diverter–treated sidewall aneurysms.

MATERIALS AND METHODS:

Flow diverter–treated sidewall aneurysms were divided into "occluded" and "residual" (incomplete occlusion) groups based on 6-month angiographic follow-up. We calculated the ostium ratio, a new parameter defined as the aneurysm ostium surface area versus the circumferential surface area of the parent artery. We also calculated the neck ratio, defined as clinical aneurysm neck diameter versus parent artery diameter from pretreatment 2D DSA, as a 2D surrogate. We compared the performance of these ratios with existing aneurysm morphometrics (size, neck diameter, volume, aspect ratio, size ratio, undulation index, nonsphericity index, ellipticity index, bottleneck factor, aneurysm angle, and parent vessel angle) and flow diverter–related parameters (metal coverage rate and pore density). Statistical tests and receiver operating characteristic analyses were performed to identify significantly different parameters between the 2 groups and test their predictive performances.

RESULTS:

We included 63 flow diverter–treated aneurysms, 46 occluded and 17 residual. The ostium ratio and neck ratio were significantly higher in the residual group than in the occluded group (P < .001 and P = .02, respectively), whereas all other parameters showed no statistical difference. As discriminating parameters for occlusion, ostium ratio and neck ratio achieved areas under the curve of 0.912 (95% CI, 0.838–0.985) and 0.707 (95% CI, 0.558–0.856), respectively.

CONCLUSIONS:

High ostium ratios and neck ratios could predict incomplete occlusion of flow diverter–treated sidewall aneurysms. Neck ratio can be easily calculated by interventionists to predict flow-diverter treatment outcomes.

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FDG-PET and MRI in the Evolution of New-Onset Refractory Status Epilepticus [ADULT BRAIN]

BACKGROUND AND PURPOSE:

New-onset refractory status epilepticus is a clinical condition characterized by acute and prolonged pharmacoresistant seizures without a pre-existing relevant neurologic disorder, prior epilepsy, or clear structural, toxic, or metabolic cause. New-onset refractory status epilepticus is often associated with antineuronal antibodies and may respond to early immunosuppressive therapy, reflecting an inflammatory element of the condition. FDG-PET is a useful diagnostic tool in inflammatory and noninflammatory encephalitis. We report here FDG-PET findings in new-onset refractory status epilepticus and their correlation to disease activity, other imaging findings, and outcomes.

MATERIALS AND METHODS:

Twelve patients who met the criteria for new-onset refractory status epilepticus and who had FDG-PET and MR imaging scans and electroencephalography at a single academic medical center between 2008 and 2017 were retrospectively identified. Images were independently reviewed by 2 radiologists specialized in nuclear imaging. Clinical characteristics and outcome measures were collected through chart review.

RESULTS:

Twelve patients underwent 21 FDG-PET scans and 50 MR imaging scans. Nine (75%) patients were positive for autoantibodies. All patients had identifiable abnormalities on the initial FDG-PET in the form of hypermetabolism (83%) and/or hypometabolism (42%). Eight (67%) had medial temporal involvement. All patients (n = 3) with N-methyl-D-aspartic acid receptor antibodies had profound bilateral occipital hypometabolism. Initial MR imaging findings were normal in 6 (50%) patients. Most patients had some degree of persistent hyper- (73%) or hypometabolism (45%) after immunosuppressive therapy. FDG-PET hypometabolism was predictive of poor outcome (mRS 4–6) at hospital discharge (P = .028).

CONCLUSIONS:

Both FDG-PET hypometabolism and hypermetabolism are seen in the setting of new-onset refractory status epilepticus and may represent markers of disease activity.

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Engorged Medullary Veins in Neurosarcoidosis: A Reflection of Underlying Phlebitis? [LETTERS]

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Measuring Glymphatic Flow in Man Using Quantitative Contrast-Enhanced MRI [ADULT BRAIN]

SUMMARY:

On the basis of animal models, glymphatic flow disruption is hypothesized to be a factor in the development of Alzheimer's disease. We report the first quantitative study of glymphatic flow in man, combining intrathecal administration of gadobutrol with serial T1 mapping to produce contrast concentration maps up to 3 days postinjection, demonstrating performing a quantitative study using the techniques described feasibility and providing data on pharmacokinetics.

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Is Delayed Speech Development a Long-Term Sequela of Birth-Related Subdural Hematoma? [LETTERS]

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Cavum Septum Pellucidum in the General Pediatric Population and Its Relation to Surrounding Brain Structure Volumes, Cognitive Function, and Emotional or Behavioral Problems [PEDIATRICS]

BACKGROUND AND PURPOSE:

The cavum septum pellucidum, a cavity filled with CSF, is localized between the 2 lateral ventricles of the brain. The cavum is present in all neonates, but it typically closes within 5 months after birth. In some cases, this closure does not occur and a persistent or enlarged cavum septum pellucidum has been linked, in some studies, to psychiatric disorders. However, the clinical relevance in the general population is unknown. In this study, we examined the relationship between the cavum septum pellucidum and volumes of brain structures, cognitive function, and emotional and behavioral problems in children.

MATERIALS AND METHODS:

This study was embedded in the Generation R Study, a prospective cohort in Rotterdam, the Netherlands. MR imaging studies of 1070 children, 6–10 years of age, were systematically evaluated for the presence and length of a persistent cavum septum pellucidum. An enlarged cavum septum pellucidum was defined as a cavum length of ≥6 mm. Groups without, with persistent, and with enlarged cavum septi pellucidi were compared for brain structure volumes, nonverbal intelligence, and emotional and behavioral problems.

RESULTS:

The prevalence of cavum septi pellucidi in our sample was 4.6%. Children with an enlarged cavum septum pellucidum had a larger corpus callosum, greater thalamic and total white matter–to–total brain volume ratio, and smaller lateral ventricle volumes. We did not find a relationship between cavum septi pellucidi and cognitive function or emotional and behavioral problems.

CONCLUSIONS:

The cavum septum pellucidum is a normal structural brain variation without clinical implications in this population-based sample of school-aged children.

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Reply: [LETTERS]

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Contrast-Enhanced 3D-FLAIR Imaging of the Optic Nerve and Optic Nerve Head: Novel Neuroimaging Findings of Idiopathic Intracranial Hypertension [HEAD & NECK]

BACKGROUND AND PURPOSE:

The sensitivity of contrast-enhanced 3D-FLAIR has not been assessed in patients with idiopathic intracranial hypertension. The purpose of this study was to evaluate whether hyperintensity of the optic nerve/optic nerve head on contrast-enhanced 3D-FLAIR imaging is associated with papilledema in patients with idiopathic intracranial hypertension.

MATERIALS AND METHODS:

A retrospective review was conducted from 2012 to 2015 of patients with clinically diagnosed idiopathic intracranial hypertension and age- and sex-matched controls who had MR imaging with contrast-enhanced 3D-FLAIR. Two neuroradiologists graded each optic nerve/optic nerve head on a scale of 0–3. This grade was then correlated with the Frisén Scale, an ophthalmologic scale used for grading papilledema from 0 (normal) to 5 (severe edema). To estimate the correlation between the MR imaging and Frisén scores, we calculated the Kendall coefficient.

RESULTS:

Forty-six patients (3 men, 43 women) with idiopathic intracranial hypertension and 61 controls (5 men, 56 women) with normal findings on MR imaging were included in this study. For both eyes, there was moderate correlation between the 2 scales (right eye: = 0.47; 95% CI, 0.31–0.57; left eye: = 0.38; 95% CI, 0.24–0.49). Interreader reliability for MR imaging scores showed high interreader reliability (right eye: = 0.76; 95% CI, 0.55–0.88; left eye: = 0.87; 95% CI, 0.78–0.94). Contrast-enhanced 3D-FLAIR imaging correlates with the Frisén Scale for moderate-to-severe papilledema and less so for mild papilledema.

CONCLUSIONS:

Hyperintensity of the optic nerve/optic nerve head on contrast-enhanced 3D-FLAIR is sensitive for the detection of papilledema in patients with idiopathic intracranial hypertension, which may be useful when prompt diagnosis is crucial.

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Quantitative Susceptibility Mapping to Assess Cerebral Vascular Compliance [ADULT BRAIN]

SUMMARY:

This study explored whether autoregulatory shifts in cerebral blood volume induce susceptibility changes large enough to be depicted by quantitative susceptibility mapping. Eight healthy subjects underwent fast quantitative susceptibility mapping at 3T while lying down to slowly decrease mean arterial pressure. A linear relationship between mean arterial pressure and susceptibility was observed in cortical and subcortical structures, likely representing vessels involved in autoregulation. The slope of this relationship is assumed to indicate the extent of cerebral vascular compliance.

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Endothelialization following Flow Diversion for Intracranial Aneurysms: A Systematic Review [INTERVENTIONAL]

BACKGROUND:

The underlying mechanism of action of flow diverters is believed to be the induction of aneurysm thrombosis and simultaneous endothelial cell growth along the device struts, thereby facilitating aneurysm exclusion from the circulation. Although extensive attention has been paid to the role of altered cerebrovascular hemodynamics using computational fluid dynamics analyses, relatively less emphasis has been placed on the role of the vascular endothelium in promoting aneurysm healing.

PURPOSE:

Our aim was to systematically review all available literature investigating the mechanism of action of flow diverters in both human patients and preclinical models.

DATA SOURCES:

A systematic search of PubMed, Cochrane Central Register of Controlled Trials MEDLINE, EMBASE, and the Web of Science electronic data bases was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines.

STUDY SELECTION:

We selected articles assessing the role of endothelialization in flow-diverter treatment of cerebral aneurysms, including both preclinical and clinical studies.

DATA ANALYSIS:

Ten articles were eligible for inclusion in this review. Two assessed endothelialization in human patients, while the other 8 used preclinical models (either rabbits or pigs).

DATA SYNTHESIS:

Methods used to assess endothelialization included optical coherence tomography and scanning electron microscopy.

LIMITATIONS:

A limitation was the heterogeneity of studies.

CONCLUSIONS:

Current data regarding the temporal relationship to flow-diverter placement has largely been derived from work in preclinical animal models. Whether these cells along the device struts originate from adjacent endothelial cells or are the result of homing of circulating endothelial progenitor cells is equivocal.

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Reply: [LETTERS]

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Reply: [LETTERS]

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Acute and Evolving MRI of High-Altitude Cerebral Edema: Microbleeds, Edema, and Pathophysiology [ADULT BRAIN]

SUMMARY:

MR imaging of high-altitude cerebral edema shows reversible WM edema, especially in the corpus callosum and subcortical WM. Recent studies have revealed hemosiderin deposition in WM long after high-altitude cerebral edema has resolved, providing a high-altitude cerebral edema "footprint." We wished to determine whether these microbleeds are present acutely and also describe the evolution of all MR imaging findings. In 8 patients with severe high-altitude cerebral edema, we obtained 26 studies: 18 with 3T and 8 with 1.5T scanners, during the acute stage, recovery, and follow-up in 7 patients and acutely in 1 patient. Imaging confirmed reversible cytotoxic and vasogenic WM edema that unexpectedly worsened the first week during clinical improvement before resolving. The 3T SWI, but not 1.5T imaging, showed extensive microbleeds extending beyond areas of edema seen acutely, which persisted and with time coalesced. These findings support cytotoxic and vasogenic edema leading to capillary failure/leakage in the pathophysiology of high-altitude cerebral edema and provide imaging correlation to the clinical course.

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Alterations in Brain Metabolites in Patients with Epilepsy with Impaired Consciousness: A Case-Control Study of Interictal Multivoxel 1H-MRS Findings [ADULT BRAIN]

BACKGROUND AND PURPOSE:

Previous studies have shown perfusion abnormalities in the thalamus and upper brain stem in patients with epilepsy with impaired consciousness. We hypothesized that these areas associated with consciousness will also show metabolic abnormalities. However, metabolic abnormalities in those areas correlated with consciousness has not been characterized with multiple-voxel ¹H-MRS. In this study, we investigated the metabolic alterations in these brain regions and assessed the correlation between seizure features and metabolic alterations.

MATERIALS AND METHODS:

Fifty-seven patients with epilepsy and 24 control subjects underwent routine MR imaging and 3D multiple-voxel ¹H-MRS. Patients were divided into 3 subgroups: focal impaired awareness seizures (n = 18), primary generalized tonic-clonic seizures (n = 19), and secondary generalized tonic-clonic seizures (n = 20). The measured metabolite alterations in NAA/Cr, NAA/(Cr + Cho), and Cho/Cr ratios in brain regions associated with the consciousness network were compared between the patient and control groups. ROIs were placed in the bilateral inferior frontal gyrus, supramarginal gyrus, cingulate gyrus, precuneus, thalamus, and upper brain stem. Correlations between clinical parameters (epilepsy duration and seizure frequency) and metabolite alterations were analyzed.

RESULTS:

Significantly lower NAA/Cr and NAA/(Cho + Cr) ratios (P < .05 and < .01, respectively) were observed in the bilateral thalamus and upper brain stem in all experimental groups, and significantly high Cho/Cr ratios (P < .05) were observed in the right thalamus in the focal impaired awareness seizures group. There were no significant differences in metabolite ratios among the 3 patient groups (P > .05). The secondary generalized tonic-clonic seizures group showed a negative correlation between the duration of epilepsy and the NAA/(Cr + Cho) ratio in the bilateral thalamus (P < .05).

CONCLUSIONS:

Metabolic alterations were observed in the brain stem and thalamus in patients with epilepsy with impaired consciousness.

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Acute Toxic Leukoencephalopathy: Etiologies, Imaging Findings, and Outcomes in 101 Patients [ADULT BRAIN]

BACKGROUND AND PURPOSE:

Prior studies regarding acute toxic leukoencephalopathy (ATL) are either small, or preliminary. Our aim was to evaluate etiologies of and differences in imaging severity and outcomes among various etiologies of ATL.

MATERIALS AND METHODS:

MRIs of patients with suspected ATL over 15 years were retrospectively reviewed; inclusion criteria were: MRI <3 weeks of presentation with both DWI and FLAIR. These were jointly graded by two neuroradiologists via a previously described score of severity. Clinical outcome was evaluated via both modified Rankin (mRS) and ATL outcome (ATLOS) scores, each being correlated with the DWI and FLAIR scores. Etiologic subgroups of n > 6 patients were statistically compared.

RESULTS:

Of 101 included patients, the 4 subgroups of n > 6 were the following: chemotherapy (n = 35), opiates (n = 19), acute hepatic encephalopathy (n = 14), and immunosuppressants (n = 11). Other causes (n = 22 total) notably included carbon monoxide (n = 3) metronidazole (n = 2), and uremia (n = 1). The mean DWI/FLAIR severity scores were 2.6/2.3, 3.3/3.3, 2.1/2.1 and 2.0/2.5 for chemotherapeutics, opiates, AHE and immunosuppressants, respectively, with significant differences in both imaging severity and outcome (P = .003–.032) among subgroups, particularly immunosuppressant versus chemotherapy-related ATL and immunosuppressants versus opiates (P = .004–.032) related ATL. DWI and FLAIR severity weakly correlated with outcome ( = 0.289–.349, P < .005) but correlated stronger in the chemotherapy ( = 0.460–.586, P < .010) and opiate ( =.472–.608, P < .05) subgroups, which had the worst outcomes. ATL clinically resolved in 36%, with severe outcomes in 23% (coma or death, 9/16 deaths from fludarabine). Notable laboratory results were elevated CSF myelin basic protein levels in 8/9 patients and serum blood urea nitrogen levels in 24/91.

CONCLUSIONS:

Clinical outcomes of ATL vary on the basis of etiology, being worse in chemotherapeutic- and opiate-related ATL. Uremia may be a predisposing or exacerbating factor.

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A 3T Phase-Sensitive Inversion Recovery MRI Sequence Improves Detection of Cervical Spinal Cord Lesions and Shows Active Lesions in Patients with Multiple Sclerosis [SPINE]

BACKGROUND AND PURPOSE:

Magnetic Resonance Imaging is the modality of choice to detect spinal cord lesions in patients with Multiple Sclerosis (MS). However, this imaging is challenging. New sequences such as phase-sensitive inversion recovery have been developed to improve detection. Our aim was to compare a 3D phase-sensitive inversion recovery and a conventional imaging dataset including postcontrast T2WI and T1WI to detect MS spinal cord lesions.

MATERIALS AND METHODS:

This retrospective single-center study included 100 consecutive patients with MS (mean age, 41 years) from January 2015 to June 2016. One senior neuroradiologist and 1 junior radiologist blinded to clinical data checked for new spinal cord lesions, individually analyzing conventional and 3D phase-sensitive inversion recovery datasets separately, placing a 3-week delay between the 2 readings. A consensus reading was done with a third senior neuroradiologist. A Wilcoxon test was used to compare the 2 imaging datasets. Intra- and interobserver agreement was assessed by the coefficient.

RESULTS:

3D phase-sensitive inversion recovery detected significantly more lesions than conventional imaging (480 versus 168, P < .001). Eleven patients had no detected lesions on T2WI, whereas 3D phase-sensitive inversion recovery detected at least 1 lesion. All postcontrast T1WI enhancing lesions were also visible on 3D phase-sensitive inversion recovery. The signal-to-noise ratio was significantly higher using 3D phase-sensitive inversion recovery (0.63 versus 0.46, P = .03). Mean reading confidence was significantly higher using 3D phase-sensitive inversion recovery. Inter- and intraobserver agreement was good for both datasets.

CONCLUSIONS:

Our study showed that 3D phase-sensitive inversion recovery significantly improved detection of cervical spinal cord lesions, including both enhancing and nonenhancing lesions in patients with MS.

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Risk of Acute Kidney Injury with Consecutive, Multidose Use of Iodinated Contrast in Patients with Acute Ischemic Stroke [ADULT BRAIN]

SUMMARY:

Currently, CTA is the imaging technique most frequently used to evaluate acute ischemic stroke, and patients with intracranial large-vessel occlusion usually undergo endovascular treatment. This single-center, prospective, cohort study showed that consecutive, multidose use of contrast during CTA and DSA does not increase the incidence of acute kidney injury in patients with acute ischemic stroke, though acute kidney injury tended to have a higher incidence in the contrast multiexposure group (P = .172).

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Validating the Automatic Independent Component Analysis of DSA [INTERVENTIONAL]

SUMMARY:

Time-density curve analysis of DSA provides useful blood flow information. However, manually selecting the ROI is time-consuming. We developed an automatic technique to provide arterial, capillary, and venous vasculatures with corresponding time-density curves. This study retrospectively analyzed the data of 36 patients with unilateral carotid stenosis. We found that the full width at half maximum of the time-density curve for the automatically segmented capillary vasculature is a suitable representation of the cerebral circulation time.

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High-Resolution Vessel Wall MR Imaging as an Alternative to Brain Biopsy [LETTERS]

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The "Bovine Aortic Arch": Time to Rethink the True Origin of the Term? [LETTERS]

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Ostium Ratio and Neck Ratio Could Predict the Outcome of Sidewall Intracranial Aneurysms Treated with Flow Diverters [INTERVENTIONAL]

BACKGROUND AND PURPOSE:

Incompletely occluded flow diverter treated aneurysms remain at risk of rupture and thromboembolic complications. Our aim was to identify the potential for incomplete occlusion of intracranial aneurysms treated by flow diverters. We investigated whether aneurysm ostium size in relation to parent artery size affects angiographic outcomes of flow diverter–treated sidewall aneurysms.

MATERIALS AND METHODS:

Flow diverter–treated sidewall aneurysms were divided into "occluded" and "residual" (incomplete occlusion) groups based on 6-month angiographic follow-up. We calculated the ostium ratio, a new parameter defined as the aneurysm ostium surface area versus the circumferential surface area of the parent artery. We also calculated the neck ratio, defined as clinical aneurysm neck diameter versus parent artery diameter from pretreatment 2D DSA, as a 2D surrogate. We compared the performance of these ratios with existing aneurysm morphometrics (size, neck diameter, volume, aspect ratio, size ratio, undulation index, nonsphericity index, ellipticity index, bottleneck factor, aneurysm angle, and parent vessel angle) and flow diverter–related parameters (metal coverage rate and pore density). Statistical tests and receiver operating characteristic analyses were performed to identify significantly different parameters between the 2 groups and test their predictive performances.

RESULTS:

We included 63 flow diverter–treated aneurysms, 46 occluded and 17 residual. The ostium ratio and neck ratio were significantly higher in the residual group than in the occluded group (P < .001 and P = .02, respectively), whereas all other parameters showed no statistical difference. As discriminating parameters for occlusion, ostium ratio and neck ratio achieved areas under the curve of 0.912 (95% CI, 0.838–0.985) and 0.707 (95% CI, 0.558–0.856), respectively.

CONCLUSIONS:

High ostium ratios and neck ratios could predict incomplete occlusion of flow diverter–treated sidewall aneurysms. Neck ratio can be easily calculated by interventionists to predict flow-diverter treatment outcomes.

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FDG-PET and MRI in the Evolution of New-Onset Refractory Status Epilepticus [ADULT BRAIN]

BACKGROUND AND PURPOSE:

New-onset refractory status epilepticus is a clinical condition characterized by acute and prolonged pharmacoresistant seizures without a pre-existing relevant neurologic disorder, prior epilepsy, or clear structural, toxic, or metabolic cause. New-onset refractory status epilepticus is often associated with antineuronal antibodies and may respond to early immunosuppressive therapy, reflecting an inflammatory element of the condition. FDG-PET is a useful diagnostic tool in inflammatory and noninflammatory encephalitis. We report here FDG-PET findings in new-onset refractory status epilepticus and their correlation to disease activity, other imaging findings, and outcomes.

MATERIALS AND METHODS:

Twelve patients who met the criteria for new-onset refractory status epilepticus and who had FDG-PET and MR imaging scans and electroencephalography at a single academic medical center between 2008 and 2017 were retrospectively identified. Images were independently reviewed by 2 radiologists specialized in nuclear imaging. Clinical characteristics and outcome measures were collected through chart review.

RESULTS:

Twelve patients underwent 21 FDG-PET scans and 50 MR imaging scans. Nine (75%) patients were positive for autoantibodies. All patients had identifiable abnormalities on the initial FDG-PET in the form of hypermetabolism (83%) and/or hypometabolism (42%). Eight (67%) had medial temporal involvement. All patients (n = 3) with N-methyl-D-aspartic acid receptor antibodies had profound bilateral occipital hypometabolism. Initial MR imaging findings were normal in 6 (50%) patients. Most patients had some degree of persistent hyper- (73%) or hypometabolism (45%) after immunosuppressive therapy. FDG-PET hypometabolism was predictive of poor outcome (mRS 4–6) at hospital discharge (P = .028).

CONCLUSIONS:

Both FDG-PET hypometabolism and hypermetabolism are seen in the setting of new-onset refractory status epilepticus and may represent markers of disease activity.

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Engorged Medullary Veins in Neurosarcoidosis: A Reflection of Underlying Phlebitis? [LETTERS]

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Measuring Glymphatic Flow in Man Using Quantitative Contrast-Enhanced MRI [ADULT BRAIN]

SUMMARY:

On the basis of animal models, glymphatic flow disruption is hypothesized to be a factor in the development of Alzheimer's disease. We report the first quantitative study of glymphatic flow in man, combining intrathecal administration of gadobutrol with serial T1 mapping to produce contrast concentration maps up to 3 days postinjection, demonstrating performing a quantitative study using the techniques described feasibility and providing data on pharmacokinetics.

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Is Delayed Speech Development a Long-Term Sequela of Birth-Related Subdural Hematoma? [LETTERS]

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Cavum Septum Pellucidum in the General Pediatric Population and Its Relation to Surrounding Brain Structure Volumes, Cognitive Function, and Emotional or Behavioral Problems [PEDIATRICS]

BACKGROUND AND PURPOSE:

The cavum septum pellucidum, a cavity filled with CSF, is localized between the 2 lateral ventricles of the brain. The cavum is present in all neonates, but it typically closes within 5 months after birth. In some cases, this closure does not occur and a persistent or enlarged cavum septum pellucidum has been linked, in some studies, to psychiatric disorders. However, the clinical relevance in the general population is unknown. In this study, we examined the relationship between the cavum septum pellucidum and volumes of brain structures, cognitive function, and emotional and behavioral problems in children.

MATERIALS AND METHODS:

This study was embedded in the Generation R Study, a prospective cohort in Rotterdam, the Netherlands. MR imaging studies of 1070 children, 6–10 years of age, were systematically evaluated for the presence and length of a persistent cavum septum pellucidum. An enlarged cavum septum pellucidum was defined as a cavum length of ≥6 mm. Groups without, with persistent, and with enlarged cavum septi pellucidi were compared for brain structure volumes, nonverbal intelligence, and emotional and behavioral problems.

RESULTS:

The prevalence of cavum septi pellucidi in our sample was 4.6%. Children with an enlarged cavum septum pellucidum had a larger corpus callosum, greater thalamic and total white matter–to–total brain volume ratio, and smaller lateral ventricle volumes. We did not find a relationship between cavum septi pellucidi and cognitive function or emotional and behavioral problems.

CONCLUSIONS:

The cavum septum pellucidum is a normal structural brain variation without clinical implications in this population-based sample of school-aged children.

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Reply: [LETTERS]

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Contrast-Enhanced 3D-FLAIR Imaging of the Optic Nerve and Optic Nerve Head: Novel Neuroimaging Findings of Idiopathic Intracranial Hypertension [HEAD & NECK]

BACKGROUND AND PURPOSE:

The sensitivity of contrast-enhanced 3D-FLAIR has not been assessed in patients with idiopathic intracranial hypertension. The purpose of this study was to evaluate whether hyperintensity of the optic nerve/optic nerve head on contrast-enhanced 3D-FLAIR imaging is associated with papilledema in patients with idiopathic intracranial hypertension.

MATERIALS AND METHODS:

A retrospective review was conducted from 2012 to 2015 of patients with clinically diagnosed idiopathic intracranial hypertension and age- and sex-matched controls who had MR imaging with contrast-enhanced 3D-FLAIR. Two neuroradiologists graded each optic nerve/optic nerve head on a scale of 0–3. This grade was then correlated with the Frisén Scale, an ophthalmologic scale used for grading papilledema from 0 (normal) to 5 (severe edema). To estimate the correlation between the MR imaging and Frisén scores, we calculated the Kendall coefficient.

RESULTS:

Forty-six patients (3 men, 43 women) with idiopathic intracranial hypertension and 61 controls (5 men, 56 women) with normal findings on MR imaging were included in this study. For both eyes, there was moderate correlation between the 2 scales (right eye: = 0.47; 95% CI, 0.31–0.57; left eye: = 0.38; 95% CI, 0.24–0.49). Interreader reliability for MR imaging scores showed high interreader reliability (right eye: = 0.76; 95% CI, 0.55–0.88; left eye: = 0.87; 95% CI, 0.78–0.94). Contrast-enhanced 3D-FLAIR imaging correlates with the Frisén Scale for moderate-to-severe papilledema and less so for mild papilledema.

CONCLUSIONS:

Hyperintensity of the optic nerve/optic nerve head on contrast-enhanced 3D-FLAIR is sensitive for the detection of papilledema in patients with idiopathic intracranial hypertension, which may be useful when prompt diagnosis is crucial.

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Quantitative Susceptibility Mapping to Assess Cerebral Vascular Compliance [ADULT BRAIN]

SUMMARY:

This study explored whether autoregulatory shifts in cerebral blood volume induce susceptibility changes large enough to be depicted by quantitative susceptibility mapping. Eight healthy subjects underwent fast quantitative susceptibility mapping at 3T while lying down to slowly decrease mean arterial pressure. A linear relationship between mean arterial pressure and susceptibility was observed in cortical and subcortical structures, likely representing vessels involved in autoregulation. The slope of this relationship is assumed to indicate the extent of cerebral vascular compliance.

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Endothelialization following Flow Diversion for Intracranial Aneurysms: A Systematic Review [INTERVENTIONAL]

BACKGROUND:

The underlying mechanism of action of flow diverters is believed to be the induction of aneurysm thrombosis and simultaneous endothelial cell growth along the device struts, thereby facilitating aneurysm exclusion from the circulation. Although extensive attention has been paid to the role of altered cerebrovascular hemodynamics using computational fluid dynamics analyses, relatively less emphasis has been placed on the role of the vascular endothelium in promoting aneurysm healing.

PURPOSE:

Our aim was to systematically review all available literature investigating the mechanism of action of flow diverters in both human patients and preclinical models.

DATA SOURCES:

A systematic search of PubMed, Cochrane Central Register of Controlled Trials MEDLINE, EMBASE, and the Web of Science electronic data bases was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines.

STUDY SELECTION:

We selected articles assessing the role of endothelialization in flow-diverter treatment of cerebral aneurysms, including both preclinical and clinical studies.

DATA ANALYSIS:

Ten articles were eligible for inclusion in this review. Two assessed endothelialization in human patients, while the other 8 used preclinical models (either rabbits or pigs).

DATA SYNTHESIS:

Methods used to assess endothelialization included optical coherence tomography and scanning electron microscopy.

LIMITATIONS:

A limitation was the heterogeneity of studies.

CONCLUSIONS:

Current data regarding the temporal relationship to flow-diverter placement has largely been derived from work in preclinical animal models. Whether these cells along the device struts originate from adjacent endothelial cells or are the result of homing of circulating endothelial progenitor cells is equivocal.

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Reply: [LETTERS]

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Reply: [LETTERS]

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Acute and Evolving MRI of High-Altitude Cerebral Edema: Microbleeds, Edema, and Pathophysiology [ADULT BRAIN]

SUMMARY:

MR imaging of high-altitude cerebral edema shows reversible WM edema, especially in the corpus callosum and subcortical WM. Recent studies have revealed hemosiderin deposition in WM long after high-altitude cerebral edema has resolved, providing a high-altitude cerebral edema "footprint." We wished to determine whether these microbleeds are present acutely and also describe the evolution of all MR imaging findings. In 8 patients with severe high-altitude cerebral edema, we obtained 26 studies: 18 with 3T and 8 with 1.5T scanners, during the acute stage, recovery, and follow-up in 7 patients and acutely in 1 patient. Imaging confirmed reversible cytotoxic and vasogenic WM edema that unexpectedly worsened the first week during clinical improvement before resolving. The 3T SWI, but not 1.5T imaging, showed extensive microbleeds extending beyond areas of edema seen acutely, which persisted and with time coalesced. These findings support cytotoxic and vasogenic edema leading to capillary failure/leakage in the pathophysiology of high-altitude cerebral edema and provide imaging correlation to the clinical course.

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Alterations in Brain Metabolites in Patients with Epilepsy with Impaired Consciousness: A Case-Control Study of Interictal Multivoxel 1H-MRS Findings [ADULT BRAIN]

BACKGROUND AND PURPOSE:

Previous studies have shown perfusion abnormalities in the thalamus and upper brain stem in patients with epilepsy with impaired consciousness. We hypothesized that these areas associated with consciousness will also show metabolic abnormalities. However, metabolic abnormalities in those areas correlated with consciousness has not been characterized with multiple-voxel ¹H-MRS. In this study, we investigated the metabolic alterations in these brain regions and assessed the correlation between seizure features and metabolic alterations.

MATERIALS AND METHODS:

Fifty-seven patients with epilepsy and 24 control subjects underwent routine MR imaging and 3D multiple-voxel ¹H-MRS. Patients were divided into 3 subgroups: focal impaired awareness seizures (n = 18), primary generalized tonic-clonic seizures (n = 19), and secondary generalized tonic-clonic seizures (n = 20). The measured metabolite alterations in NAA/Cr, NAA/(Cr + Cho), and Cho/Cr ratios in brain regions associated with the consciousness network were compared between the patient and control groups. ROIs were placed in the bilateral inferior frontal gyrus, supramarginal gyrus, cingulate gyrus, precuneus, thalamus, and upper brain stem. Correlations between clinical parameters (epilepsy duration and seizure frequency) and metabolite alterations were analyzed.

RESULTS:

Significantly lower NAA/Cr and NAA/(Cho + Cr) ratios (P < .05 and < .01, respectively) were observed in the bilateral thalamus and upper brain stem in all experimental groups, and significantly high Cho/Cr ratios (P < .05) were observed in the right thalamus in the focal impaired awareness seizures group. There were no significant differences in metabolite ratios among the 3 patient groups (P > .05). The secondary generalized tonic-clonic seizures group showed a negative correlation between the duration of epilepsy and the NAA/(Cr + Cho) ratio in the bilateral thalamus (P < .05).

CONCLUSIONS:

Metabolic alterations were observed in the brain stem and thalamus in patients with epilepsy with impaired consciousness.

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Role of a two-step suture in the prevention of postoperative transoral salivary fistulas during reconstruction of the oral cavity

Transoral salivary fistulas are one of the most serious postoperative complications after operations for oral cancer, and we propose a new, two-step suture method to avoid them. From January 2005 to September 2017, 240 patients were recruited at the Shanghai Ninth People 's Hospital and divided into experimental (n=89) or control (n=151) groups. The experimental group was treated by a two-step suture technique, while the control group had conventional sutures. Statistical differences were assessed using the chi squared and t tests, as appropriate. (Source: The British Journal of Oral and Maxillofacial Surgery)

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Role of a two-step suture in the prevention of postoperative transoral salivary fistulas during reconstruction of the oral cavity

Transoral salivary fistulas are one of the most serious postoperative complications after operations for oral cancer, and we propose a new, two-step suture method to avoid them. From January 2005 to September 2017, 240 patients were recruited at the Shanghai Ninth People 's Hospital and divided into experimental (n=89) or control (n=151) groups. The experimental group was treated by a two-step suture technique, while the control group had conventional sutures. Statistical differences were assessed using the chi squared and t tests, as appropriate. (Source: The British Journal of Oral and Maxillofacial Surgery)

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Eine seltene Ursache der chronischen Otitis media

Laryngo-Rhino-Otol
DOI: 10.1055/a-0829-6950

© Georg Thieme Verlag KG Stuttgart · New York

Article in Thieme eJournals:
Table of contents  |  Full text

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Eine Gruppenintervention zur Förderung der Arbeitsfähigkeit für Patienten mit Kopf-Hals-Tumoren

Laryngo-Rhino-Otol
DOI: 10.1055/a-0829-6885

Einleitung Trotz hoher Belastung nimmt ein Großteil der Patienten mit Kopf-Hals-Tumoren keine psychosoziale Versorgung in Anspruch. Diese Patienten haben darüber hinaus ein höheres Risiko als andere Krebspatienten, nicht wieder in den Beruf zurückzukehren. Daher wurde eine Gruppenintervention entwickelt, die sich an Patienten mit Kopf-Hals-Tumoren richtet und deren Arbeitsfähigkeit, Lebensqualität, Selbstwirksamkeit und psychisches Wohlbefinden fördern soll. Material und Methoden In einem randomisiert-kontrollierten Design erhalten die Patienten eine Gruppenintervention oder eine sozialrechtliche Beratung. Eingeschlossen werden männliche Patienten mit Kopf-Hals-Tumoren mit hoher psychischer und arbeitsbezogener Belastung. Die Gruppenintervention besteht aus acht Sitzungen. Die Gruppen werden von einer Psychotherapeutin und einem ehemals Betroffenen eines Kopf-Hals-Tumors (sogenannter Peer) geleitet. Die Umsetzbarkeit und Akzeptanz der Intervention wurde anhand einer Pilotgruppe getestet. Die Teilnehmer der Pilotgruppe evaluierten jede Sitzung und wurden nach Abschluss der Intervention in halbstrukturierten Interviews zur Intervention befragt. Ergebnisse Von 113 Patienten persönlich angesprochenen Patienten nahmen zehn Patienten an einem Screening-Gespräch teil. Davon nahmen vier Patienten an der Pilotgruppe teil. Die Patienten gaben an, dass sich die Gruppenintervention gut mit ihrem Alltag vereinbaren ließe und dass sie die Gruppe insgesamt positiv wahrgenommen hätten. Drei Patienten betonten die Wichtigkeit des Peers. Diskussion Vor allem der Peers als Identifikationsfigur ist von zentraler Bedeutung. Zur Verbesserung der Rekrutierungszahlen sollen Einschlusskriterien erweitert und der Teilnahmeaufwand reduziert werden.
[...]

© Georg Thieme Verlag KG Stuttgart · New York

Article in Thieme eJournals:
Table of contents  |  Abstract  |  Full text

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Eine seltene Ursache der chronischen Otitis media

Laryngo-Rhino-Otol
DOI: 10.1055/a-0829-6950

© Georg Thieme Verlag KG Stuttgart · New York

Article in Thieme eJournals:
Table of contents  |  Full text

from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader http://bit.ly/2TeIJn1

Eine Gruppenintervention zur Förderung der Arbeitsfähigkeit für Patienten mit Kopf-Hals-Tumoren

Laryngo-Rhino-Otol
DOI: 10.1055/a-0829-6885

Einleitung Trotz hoher Belastung nimmt ein Großteil der Patienten mit Kopf-Hals-Tumoren keine psychosoziale Versorgung in Anspruch. Diese Patienten haben darüber hinaus ein höheres Risiko als andere Krebspatienten, nicht wieder in den Beruf zurückzukehren. Daher wurde eine Gruppenintervention entwickelt, die sich an Patienten mit Kopf-Hals-Tumoren richtet und deren Arbeitsfähigkeit, Lebensqualität, Selbstwirksamkeit und psychisches Wohlbefinden fördern soll. Material und Methoden In einem randomisiert-kontrollierten Design erhalten die Patienten eine Gruppenintervention oder eine sozialrechtliche Beratung. Eingeschlossen werden männliche Patienten mit Kopf-Hals-Tumoren mit hoher psychischer und arbeitsbezogener Belastung. Die Gruppenintervention besteht aus acht Sitzungen. Die Gruppen werden von einer Psychotherapeutin und einem ehemals Betroffenen eines Kopf-Hals-Tumors (sogenannter Peer) geleitet. Die Umsetzbarkeit und Akzeptanz der Intervention wurde anhand einer Pilotgruppe getestet. Die Teilnehmer der Pilotgruppe evaluierten jede Sitzung und wurden nach Abschluss der Intervention in halbstrukturierten Interviews zur Intervention befragt. Ergebnisse Von 113 Patienten persönlich angesprochenen Patienten nahmen zehn Patienten an einem Screening-Gespräch teil. Davon nahmen vier Patienten an der Pilotgruppe teil. Die Patienten gaben an, dass sich die Gruppenintervention gut mit ihrem Alltag vereinbaren ließe und dass sie die Gruppe insgesamt positiv wahrgenommen hätten. Drei Patienten betonten die Wichtigkeit des Peers. Diskussion Vor allem der Peers als Identifikationsfigur ist von zentraler Bedeutung. Zur Verbesserung der Rekrutierungszahlen sollen Einschlusskriterien erweitert und der Teilnahmeaufwand reduziert werden.
[...]

© Georg Thieme Verlag KG Stuttgart · New York

Article in Thieme eJournals:
Table of contents  |  Abstract  |  Full text

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Age-specific changes in the molecular phenotype of patients with moderate-to-severe atopic dermatitis

This study identifies significant age-specific changes in the molecular profile of moderate-to-severe AD patients, including key variations in T-helper polarization and barrier measures. These changes may direct development of age-specific targeted therapeutics for AD patients.

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Maternal allergen-specific IgG may protect the child against allergic sensitization

The analysis of blood samples from mothers during third trimester and cord blood for IgG reactivity to a comprehensive panel of 164 allergens in the ALADDIN birth cohort indicates that children from mothers with high allergen-specific IgG do not develop allergic sensitization.

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Clinical features and mechanistic insights regarding IgG4-related dacryoadenitis and sialoadenitis: a review

Immunoglobulin G4-related disease (IgG4-RD), recognized only recently as a single diagnostic entity, is a chronic inflammatory condition of unknown etiology. The diagnosis of IgG4-RD relies heavily on histopathological analysis and the correlation of histology findings with clinical, serological, and radiological data. CD4+ T and B cells, including IgG4-expressing plasmablasts, constitute the major inflammatory cell populations in IgG4-RD and are believed to cause organ damage and tissue fibrosis.

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Age-specific changes in the molecular phenotype of patients with moderate-to-severe atopic dermatitis

This study identifies significant age-specific changes in the molecular profile of moderate-to-severe AD patients, including key variations in T-helper polarization and barrier measures. These changes may direct development of age-specific targeted therapeutics for AD patients.

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Maternal allergen-specific IgG may protect the child against allergic sensitization

The analysis of blood samples from mothers during third trimester and cord blood for IgG reactivity to a comprehensive panel of 164 allergens in the ALADDIN birth cohort indicates that children from mothers with high allergen-specific IgG do not develop allergic sensitization.

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Clinical features and mechanistic insights regarding IgG4-related dacryoadenitis and sialoadenitis: a review

Immunoglobulin G4-related disease (IgG4-RD), recognized only recently as a single diagnostic entity, is a chronic inflammatory condition of unknown etiology. The diagnosis of IgG4-RD relies heavily on histopathological analysis and the correlation of histology findings with clinical, serological, and radiological data. CD4+ T and B cells, including IgG4-expressing plasmablasts, constitute the major inflammatory cell populations in IgG4-RD and are believed to cause organ damage and tissue fibrosis.

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Role of a two-step suture in the prevention of postoperative transoral salivary fistulas during reconstruction of the oral cavity

Transoral salivary fistulas are one of the most serious postoperative complications after operations for oral cancer, and we propose a new, two-step suture method to avoid them. From January 2005 to September 2017, 240 patients were recruited at the Shanghai Ninth People's Hospital and divided into experimental (n=89) or control (n=151) groups. The experimental group was treated by a two-step suture technique, while the control group had conventional sutures. Statistical differences were assessed using the chi squared and t tests, as appropriate.

from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader http://bit.ly/2sOoPDL

Role of a two-step suture in the prevention of postoperative transoral salivary fistulas during reconstruction of the oral cavity

Transoral salivary fistulas are one of the most serious postoperative complications after operations for oral cancer, and we propose a new, two-step suture method to avoid them. From January 2005 to September 2017, 240 patients were recruited at the Shanghai Ninth People's Hospital and divided into experimental (n=89) or control (n=151) groups. The experimental group was treated by a two-step suture technique, while the control group had conventional sutures. Statistical differences were assessed using the chi squared and t tests, as appropriate.

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Overheard: Helping Students with ASD Handle Real or Perceived Bullying

In an online chat, SLP Erin Mauldin discusses how to teach students with ASD strategies for understanding and responding to bullying. Participant: Would you give an example of backhanded bullying? Erin Mauldin: Backhanded bullying happens when someone uses kind gestures or words with the intent of misleading their victim. A bully may say something in a nice or kind manner but the message may be negative, which our students who lack social skills are sometimes unable to interpret. A bully may take advantage of their lack of understanding to trick them into a negative situation. Participant: Is there any research about whether to talk with and support the bully in these situations?  Mauldin: A lot of the research I found was about talking to the victim of bullying and prov...

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Overheard: Helping Students with ASD Handle Real or Perceived Bullying

In an online chat, SLP Erin Mauldin discusses how to teach students with ASD strategies for understanding and responding to bullying. Participant: Would you give an example of backhanded bullying? Erin Mauldin: Backhanded bullying happens when someone uses kind gestures or words with the intent of misleading their victim. A bully may say something in a nice or kind manner but the message may be negative, which our students who lack social skills are sometimes unable to interpret. A bully may take advantage of their lack of understanding to trick them into a negative situation. Participant: Is there any research about whether to talk with and support the bully in these situations?  Mauldin: A lot of the research I found was about talking to the victim of bullying and prov...

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The influence of different patient positions during rapid induction with severe regurgitation on the volume of aspirate and time to intubation: a prospective randomised manikin simulation study

Abstract

Background

Aspiration is a main contributor to morbidity and mortality in anaesthesia. The ideal patient positioning for rapid sequence induction remains controversial. A head-down tilt and full cervical spine extension (Sellick) might prevent aspiration but at the same time compromise airway management. We aimed to determine the influence of three different positions during induction of general anaesthesia on the volume of aspirate and on participants' airway management.

Methods

Eighty-four anaesthetic trainees and consultants participated in a prospective randomised simulation study. Anaesthesia was induced in reverse Trendelenburg position (+ 15°) in a manikin capable of dynamic fluid regurgitation. Participants were randomised to change to Trendelenburg position (− 15°) a) as soon as regurgitation was noticed, b) as soon as 'patient' had been anaesthetised, and c) as soon as 'patient' had been anaesthetised and with full cervical spine extension (Sellick). Primary endpoints were the aspirated volume and the time to intubation. Secondary endpoints were ratings of the laryngoscopic view and the intubation situation (0–100 mm).

Results

Combining head-down tilt with Sellick position significantly reduced aspiration (p < 0.005). Median time to intubate was longer in Sellick position (15 s [8–30]) as compared with the head in sniffing position (10 s [8–12.5]; p < 0.05). Participants found laryngoscopy more difficult in Sellick position (39.3 ± 27.9 mm) as compared with the sniffing position (23.1 ± 22.1 mm; p < 0.05). Both head-down tilt intubation situations were considered equally difficult: 34.8 ± 24.6 mm (Sniffing) vs. 44.2 ± 23.1 mm (Sellick; p = n.s).

Conclusions

In a simulated setting, using a manikin-based simulator capable of fluid regurgitation, a − 15° head-down tilt with Sellick position reduced the amount of aspirated fluid but increased the difficulty in visualising the vocal cords and prolonged the time taken to intubate. Assessing the airway management in the identical position in healthy patients without risk of aspiration might be a promising next step to take.

from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader http://bit.ly/2CGcs1o

Nickel by proxy

A 27‐year‐old Caucasian woman presented with an annular dermatitis on the flexor aspect of her right wrist. She had originally developed dermatitis on her left wrist, as she thought due to an allergic reaction to a metal watch and watch strap which she had recently acquired.

This article is protected by copyright. All rights reserved.

from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader http://bit.ly/2RMKTh3

The influence of different patient positions during rapid induction with severe regurgitation on the volume of aspirate and time to intubation: a prospective randomised manikin simulation study

Abstract

Background

Aspiration is a main contributor to morbidity and mortality in anaesthesia. The ideal patient positioning for rapid sequence induction remains controversial. A head-down tilt and full cervical spine extension (Sellick) might prevent aspiration but at the same time compromise airway management. We aimed to determine the influence of three different positions during induction of general anaesthesia on the volume of aspirate and on participants' airway management.

Methods

Eighty-four anaesthetic trainees and consultants participated in a prospective randomised simulation study. Anaesthesia was induced in reverse Trendelenburg position (+ 15°) in a manikin capable of dynamic fluid regurgitation. Participants were randomised to change to Trendelenburg position (− 15°) a) as soon as regurgitation was noticed, b) as soon as 'patient' had been anaesthetised, and c) as soon as 'patient' had been anaesthetised and with full cervical spine extension (Sellick). Primary endpoints were the aspirated volume and the time to intubation. Secondary endpoints were ratings of the laryngoscopic view and the intubation situation (0–100 mm).

Results

Combining head-down tilt with Sellick position significantly reduced aspiration (p < 0.005). Median time to intubate was longer in Sellick position (15 s [8–30]) as compared with the head in sniffing position (10 s [8–12.5]; p < 0.05). Participants found laryngoscopy more difficult in Sellick position (39.3 ± 27.9 mm) as compared with the sniffing position (23.1 ± 22.1 mm; p < 0.05). Both head-down tilt intubation situations were considered equally difficult: 34.8 ± 24.6 mm (Sniffing) vs. 44.2 ± 23.1 mm (Sellick; p = n.s).

Conclusions

In a simulated setting, using a manikin-based simulator capable of fluid regurgitation, a − 15° head-down tilt with Sellick position reduced the amount of aspirated fluid but increased the difficulty in visualising the vocal cords and prolonged the time taken to intubate. Assessing the airway management in the identical position in healthy patients without risk of aspiration might be a promising next step to take.

from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader http://bit.ly/2CGcs1o

Nickel by proxy

A 27‐year‐old Caucasian woman presented with an annular dermatitis on the flexor aspect of her right wrist. She had originally developed dermatitis on her left wrist, as she thought due to an allergic reaction to a metal watch and watch strap which she had recently acquired.

This article is protected by copyright. All rights reserved.

from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader http://bit.ly/2RMKTh3

No Evidence of Broadband Noise Having Any Harmful Effect on Hearing—Reply

In Reply Critiques of our article by Folmer and Henry et al suggest the concerns we raised about the potential harmful effects of chronic exposure to broad-band noise (BBN) are overstated, citing a lack of clinical evidence demonstrating correspondence between human symptoms and maladaptive neuroplasticity recorded in animal studies. Although we acknowledged the paucity of human studies addressing these questions in our review, we do not think it is safe to assume humans will be exempt from substantial, negative impacts of chronic BBN exposure documented in the central auditory pathways of animals. A main goal of our report was to stimulate the audiology research and clinical communities to take these compelling animal studies more seriously—and to take on the long-delayed task of carefully documenting the impacts of chronic BBN exposure on residual human hearing, on accelerated aging, and on the evolution of tinnitus itself.

from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader http://bit.ly/2FXHZ1S

No Evidence of Broadband Noise Having Any Harmful Effect on Hearing

To the Editor Attarha et al recommended that sound therapies using white noise should be avoided as treatments for tinnitus. This advice might stem from the authors' collective lack of clinical experience assessing and treating patients with tinnitus, or from their unfamiliarity with tinnitus management techniques and associated literature. In any case, before recommending that white noise should be avoided by patients with tinnitus, Attarha et al should become more familiar with how a variety of sound therapies—including broadband sounds—often help this patient population.

from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader http://bit.ly/2FMXWsK

Bullous Pemphigoid Presenting as Oropharyngeal Hemorrhage

This is a case report of a man who presented with oropharyngeal hemorrhage and impending airway compromise as the initial presentation of mucosal bullous pemphigoid.

from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader http://bit.ly/2FVKNwA

No Evidence of Broadband Noise Having Any Harmful Effect on Hearing

To the Editor Attarha et al recommended that sound therapies using white noise should be avoided as treatments for tinnitus. This advice might stem from the authors' collective lack of clinical experience assessing and treating patients with tinnitus, or from their unfamiliarity with tinnitus management techniques and associated literature. In any case, before recommending that white noise should be avoided by patients with tinnitus, Attarha et al should become more familiar with how a variety of sound therapies—including broadband sounds—often help this patient population.

from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader http://bit.ly/2FMXWsK

Association Between Migraine and Benign Paroxysmal Positional Vertigo in South Korea

This study evaluates representative patient data from the Korean National Health Insurance Service-National Sample Cohort to trace the incidence of benign paroxysmal positional vertigo among adults who experience migraine.

from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader http://bit.ly/2FMXWce

Bullous Pemphigoid Presenting as Oropharyngeal Hemorrhage

This is a case report of a man who presented with oropharyngeal hemorrhage and impending airway compromise as the initial presentation of mucosal bullous pemphigoid.

from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader http://bit.ly/2FVKNwA

No Evidence of Broadband Noise Having Any Harmful Effect on Hearing—Reply

In Reply Critiques of our article by Folmer and Henry et al suggest the concerns we raised about the potential harmful effects of chronic exposure to broad-band noise (BBN) are overstated, citing a lack of clinical evidence demonstrating correspondence between human symptoms and maladaptive neuroplasticity recorded in animal studies. Although we acknowledged the paucity of human studies addressing these questions in our review, we do not think it is safe to assume humans will be exempt from substantial, negative impacts of chronic BBN exposure documented in the central auditory pathways of animals. A main goal of our report was to stimulate the audiology research and clinical communities to take these compelling animal studies more seriously—and to take on the long-delayed task of carefully documenting the impacts of chronic BBN exposure on residual human hearing, on accelerated aging, and on the evolution of tinnitus itself.

from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader http://bit.ly/2FXHZ1S

Association Between Migraine and Benign Paroxysmal Positional Vertigo in South Korea

This study evaluates representative patient data from the Korean National Health Insurance Service-National Sample Cohort to trace the incidence of benign paroxysmal positional vertigo among adults who experience migraine.

from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader http://bit.ly/2FMXWce

Speech Functioning and Neurocognition Before Head and Neck Cancer

This cohort study examines neurocognitive functioning in patients with head and neck cancer before treatment and investigates the association between neurocognition and speech functioning.

from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader http://bit.ly/2FLAqvZ

Speech Functioning and Neurocognition Before Head and Neck Cancer

This cohort study examines neurocognitive functioning in patients with head and neck cancer before treatment and investigates the association between neurocognition and speech functioning.

from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader http://bit.ly/2FLAqvZ

The Increasing Role of Social Media in Otolaryngology

This Viewpoint examines the increasing role of social media in the practice of otolaryngology.

from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader http://bit.ly/2FVKAcM

The Increasing Role of Social Media in Otolaryngology

This Viewpoint examines the increasing role of social media in the practice of otolaryngology.

from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader http://bit.ly/2FVKAcM

No Evidence of Broadband Noise Having Any Harmful Effect on Hearing

To the Editor We are writing in response to the article by Attarha, Bigelow, and Merzenich, which concluded, "Sound therapies using unstructured, random (white) noise should be avoided as a treatment for tinnitus."^(E1) Their recommendation was based on animal studies that revealed long-term exposure to low-level broadband noise (BBN) resulted in central auditory changes that "bear striking phenomenological overlap with the persistent, widespread disinhibition of the auditory system thought to underlie tinnitus in humans."^(E2) They noted that BBN delivered from ear-level devices to treat tinnitus produces the same type of acoustic stimuli used in the animal studies. It therefore seems plausible that continuous use of BBN could affect the human auditory system in the same manner as seen in animals, suggesting the need for research to evaluate the premise. The authors, however, pointed to the animal findings as justifying a broad recommendation against the use of ear-level noise generators.

from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader http://bit.ly/2FJicLP

No Evidence of Broadband Noise Having Any Harmful Effect on Hearing

To the Editor We are writing in response to the article by Attarha, Bigelow, and Merzenich, which concluded, "Sound therapies using unstructured, random (white) noise should be avoided as a treatment for tinnitus."^(E1) Their recommendation was based on animal studies that revealed long-term exposure to low-level broadband noise (BBN) resulted in central auditory changes that "bear striking phenomenological overlap with the persistent, widespread disinhibition of the auditory system thought to underlie tinnitus in humans."^(E2) They noted that BBN delivered from ear-level devices to treat tinnitus produces the same type of acoustic stimuli used in the animal studies. It therefore seems plausible that continuous use of BBN could affect the human auditory system in the same manner as seen in animals, suggesting the need for research to evaluate the premise. The authors, however, pointed to the animal findings as justifying a broad recommendation against the use of ear-level noise generators.

from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader http://bit.ly/2FJicLP

Improving Sensitivity on Identification and Delineation of Intracranial Hemorrhage Lesion Using Cascaded Deep Learning Models

Abstract

Highly accurate detection of the intracranial hemorrhage without delay is a critical clinical issue for the diagnostic decision and treatment in an emergency room. In the context of a study on diagnostic accuracy, there is a tradeoff between sensitivity and specificity. In order to improve sensitivity while preserving specificity, we propose a cascade deep learning model constructed using two convolutional neural networks (CNNs) and dual fully convolutional networks (FCNs). The cascade CNN model is built for identifying bleeding; hereafter the dual FCN is to detect five different subtypes of intracranial hemorrhage and to delineate their lesions. Using a total of 135,974 CT images including 33,391 images labeled as bleeding, each of CNN/FCN models was trained separately on image data preprocessed by two different settings of window level/width. One is a default window (50/100[level/width]) and the other is a stroke window setting (40/40). By combining them, we obtained a better outcome on both binary classification and segmentation of hemorrhagic lesions compared to a single CNN and FCN model. In determining whether it is bleeding or not, there was around 1% improvement in sensitivity (97.91% [± 0.47]) while retaining specificity (98.76% [± 0.10]). For delineation of bleeding lesions, we obtained overall segmentation performance at 80.19% in precision and 82.15% in recall which is 3.44% improvement compared to using a single FCN model.

from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader http://bit.ly/2WiMfiu

Improving Sensitivity on Identification and Delineation of Intracranial Hemorrhage Lesion Using Cascaded Deep Learning Models

Abstract

Highly accurate detection of the intracranial hemorrhage without delay is a critical clinical issue for the diagnostic decision and treatment in an emergency room. In the context of a study on diagnostic accuracy, there is a tradeoff between sensitivity and specificity. In order to improve sensitivity while preserving specificity, we propose a cascade deep learning model constructed using two convolutional neural networks (CNNs) and dual fully convolutional networks (FCNs). The cascade CNN model is built for identifying bleeding; hereafter the dual FCN is to detect five different subtypes of intracranial hemorrhage and to delineate their lesions. Using a total of 135,974 CT images including 33,391 images labeled as bleeding, each of CNN/FCN models was trained separately on image data preprocessed by two different settings of window level/width. One is a default window (50/100[level/width]) and the other is a stroke window setting (40/40). By combining them, we obtained a better outcome on both binary classification and segmentation of hemorrhagic lesions compared to a single CNN and FCN model. In determining whether it is bleeding or not, there was around 1% improvement in sensitivity (97.91% [± 0.47]) while retaining specificity (98.76% [± 0.10]). For delineation of bleeding lesions, we obtained overall segmentation performance at 80.19% in precision and 82.15% in recall which is 3.44% improvement compared to using a single FCN model.

from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader http://bit.ly/2WiMfiu

Evaluation of osseous changes in dental panoramic radiography of thalassemia patients using mandibular indexes and fractal size analysis

Abstract

Objective

This study aimed to evaluate the radiomorphometric indexes and fractal dimension (FD) on dental panoramic radiography (DPR) of Thalassemia Major (TM) patients.

Methods

In 59 TM patients and in 59 healthy control subjects, mandibular cortical index (MCI), mandibular cortical width (MCW), panoramic mandibular index (PMI), and FD of four different regions (FD1-4) were evaluated and compared using DPRs.

Results

The distribution of MCI in TM patients was similar to control subjects (p > 0.05). The mean MCW was significantly lower in TM patients (p = 0.001). There was no significant difference in PMI between TM patients and control subjects. The mean of FD measured in the supracortical area above the angle of mandible (FD2), in the anterior to the mental foramen (FD4) and mean FD of four different regions was significantly lower in TM patients (p = 0.003, p = 0.001, and p = 0.014, respectively).

Conclusions

The radiomorphometric indices and fractal dimensions evaluated in the panoramic radiograph are capable of identifying thalassemia patients' jaw bone, and the results of DPR scanning can be used to refer these patients to appropriate medical investigation.

from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader http://bit.ly/2HwbSbZ

Evaluation of osseous changes in dental panoramic radiography of thalassemia patients using mandibular indexes and fractal size analysis

Abstract

Objective

This study aimed to evaluate the radiomorphometric indexes and fractal dimension (FD) on dental panoramic radiography (DPR) of Thalassemia Major (TM) patients.

Methods

In 59 TM patients and in 59 healthy control subjects, mandibular cortical index (MCI), mandibular cortical width (MCW), panoramic mandibular index (PMI), and FD of four different regions (FD1-4) were evaluated and compared using DPRs.

Results

The distribution of MCI in TM patients was similar to control subjects (p > 0.05). The mean MCW was significantly lower in TM patients (p = 0.001). There was no significant difference in PMI between TM patients and control subjects. The mean of FD measured in the supracortical area above the angle of mandible (FD2), in the anterior to the mental foramen (FD4) and mean FD of four different regions was significantly lower in TM patients (p = 0.003, p = 0.001, and p = 0.014, respectively).

Conclusions

The radiomorphometric indices and fractal dimensions evaluated in the panoramic radiograph are capable of identifying thalassemia patients' jaw bone, and the results of DPR scanning can be used to refer these patients to appropriate medical investigation.

from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader http://bit.ly/2HwbSbZ

Considerations for Ophthalmic Complications

To the Editor I read with interest the article by Liu et al in JAMA Facial Plastic Surgery. The authors present a well-grounded study by demonstrating the vascular anatomy in the facial and ocular region in New Zealand white rabbits, and investigate the complications of visual impairment, blindness, and death through autologous fat injection. I would like to present some points for their consideration.

from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader http://bit.ly/2RKRRTU

A Practical Guide to Managing Body Dysmorphic Disorder in the Cosmetic Surgery Setting

This Viewpoint sets out a practical guide to recognizing and managing body dysmorphic disorder in the cosmetic surgery setting.

from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader http://bit.ly/2CFV3G6

Risk Factors Associated With Complications After Treatment of Mandible Fractures

This cohort study describes the risk factors associated with complications in patients undergoing treatment for mandible fracture.

from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader http://bit.ly/2RLl0OK

Considerations for Ophthalmic Complications

To the Editor I read with interest the article by Liu et al in JAMA Facial Plastic Surgery. The authors present a well-grounded study by demonstrating the vascular anatomy in the facial and ocular region in New Zealand white rabbits, and investigate the complications of visual impairment, blindness, and death through autologous fat injection. I would like to present some points for their consideration.

from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader http://bit.ly/2RKRRTU

A Practical Guide to Managing Body Dysmorphic Disorder in the Cosmetic Surgery Setting

This Viewpoint sets out a practical guide to recognizing and managing body dysmorphic disorder in the cosmetic surgery setting.

from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader http://bit.ly/2CFV3G6

Risk Factors Associated With Complications After Treatment of Mandible Fractures

This cohort study describes the risk factors associated with complications in patients undergoing treatment for mandible fracture.

from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader http://bit.ly/2RLl0OK

Morbidity and mortality among patients with head and neck cancer in the emergency department: A national perspective

Abstract

Background

Emergency departments are playing an increasing role in cancer management. Emergency department utilization by patients with head and neck cancer, however, is unknown.

Methods

The 2009‐2011 Nationwide Emergency Department Sample was queried for patients with a principle diagnosis of head and neck cancer. Descriptive analysis was performed to characterize patient and hospital characteristics, outcomes, and charges. Logistic regression identified predictors of admission and mortality.

Results

A total of 31 390 patients were seen in the emergency department with head and neck cancer: 72.8% were admitted, 0.5% died in the emergency department, and 5.0% died during admission. Patients with cancer of unknown primary site had the greatest odds of admission (odds ration [OR]: 2.83; P < 0.0001). Privately insured patients (OR: 1.78; P = 0.001), those from higher income zip codes (OR: 1.56; P = 0.008), and those with oropharyngeal cancer (OR: 2.02; P = 0.0003) had the greatest odds of death.

Conclusion

These findings have direct implications for preventing unnecessary and costly emergency department visits, improving hospital and physician preparedness, and improving patient outcomes.

from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader http://bit.ly/2S9wBq8

Follow‐up of noninvasive follicular thyroid neoplasm with papillary‐like nuclear features (NIFTP)

from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader http://bit.ly/2Hu7QAR

Ultrasonographic swallowing examination for early detection of neopharyngeal fistula after salvage total laryngectomy: A preliminary study

Abstract

Background

The current study investigated the feasibility of ultrasonographic swallowing examination (USSE) for the evaluation of neopharynx and early detection of neopharyngeal fistula after salvage total laryngectomy.

Methods

A prospective case series‐based study involving 16 patients who underwent salvage total laryngectomy was conducted. USSE was performed on postoperative days 5‐7, and oral diet initiation was determined based on the USSE results.

Results

Fistula of the neopharynx was detected in four patients (25%) via USSE, as was the specific site of the fistula. In these patients, oral diet was delayed and immediate interventions including ultrasound‐guided fluid aspiration and compression dressing were applied, and all fistulas were subsequently closed. In the remaining 12 patients with no neopharyngeal fistula on USSE, an oral diet was started immediately and no fistula occurred.

Conclusions

USSE is a promising method for neopharynx evaluation and early detection of neopharyngeal fistula after salvage total laryngectomy.

from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader http://bit.ly/2S5fB4q

Morbidity and mortality among patients with head and neck cancer in the emergency department: A national perspective

Abstract

Background

Emergency departments are playing an increasing role in cancer management. Emergency department utilization by patients with head and neck cancer, however, is unknown.

Methods

The 2009‐2011 Nationwide Emergency Department Sample was queried for patients with a principle diagnosis of head and neck cancer. Descriptive analysis was performed to characterize patient and hospital characteristics, outcomes, and charges. Logistic regression identified predictors of admission and mortality.

Results

A total of 31 390 patients were seen in the emergency department with head and neck cancer: 72.8% were admitted, 0.5% died in the emergency department, and 5.0% died during admission. Patients with cancer of unknown primary site had the greatest odds of admission (odds ration [OR]: 2.83; P < 0.0001). Privately insured patients (OR: 1.78; P = 0.001), those from higher income zip codes (OR: 1.56; P = 0.008), and those with oropharyngeal cancer (OR: 2.02; P = 0.0003) had the greatest odds of death.

Conclusion

These findings have direct implications for preventing unnecessary and costly emergency department visits, improving hospital and physician preparedness, and improving patient outcomes.

from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader http://bit.ly/2S9wBq8

Follow‐up of noninvasive follicular thyroid neoplasm with papillary‐like nuclear features (NIFTP)

from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader http://bit.ly/2Hu7QAR

Ultrasonographic swallowing examination for early detection of neopharyngeal fistula after salvage total laryngectomy: A preliminary study

Abstract

Background

The current study investigated the feasibility of ultrasonographic swallowing examination (USSE) for the evaluation of neopharynx and early detection of neopharyngeal fistula after salvage total laryngectomy.

Methods

A prospective case series‐based study involving 16 patients who underwent salvage total laryngectomy was conducted. USSE was performed on postoperative days 5‐7, and oral diet initiation was determined based on the USSE results.

Results

Fistula of the neopharynx was detected in four patients (25%) via USSE, as was the specific site of the fistula. In these patients, oral diet was delayed and immediate interventions including ultrasound‐guided fluid aspiration and compression dressing were applied, and all fistulas were subsequently closed. In the remaining 12 patients with no neopharyngeal fistula on USSE, an oral diet was started immediately and no fistula occurred.

Conclusions

USSE is a promising method for neopharynx evaluation and early detection of neopharyngeal fistula after salvage total laryngectomy.

from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader http://bit.ly/2S5fB4q

Fetal brain development at 25–39 weeks gestational age: A preliminary study using intravoxel incoherent motion diffusion‐weighted imaging

Background

The fetal brain developmental changes of water diffusivity and perfusion has not been extensively explored.

Purpose/Hypothesis

To evaluate the fetal brain developmental changes of water diffusivity and perfusion using intravoxel incoherent motion diffusion‐weighted imaging (IVIM‐DWI).

Study Type

Prospective.

Population

Seventy‐nine normal singleton fetuses were scanned without sedation of healthy pregnant women.

Field Strength/Sequence

5 T MRI/T₁/₂‐weighted image and IVIM‐DWI.

Assessment

Pure diffusion coefficient (D), pseudodiffusion coefficient (D*), and perfusion fraction (f) values were calculated in the frontal (FWM), temporal (TWM), parietal (PWM), and occipital white matter (OWM) as well as cerebellar hemisphere (CH), basal ganglia region (BGR), thalamus (TH), and pons using an IVIM model.

Statistical Tests

One‐way analysis of variable (ANOVA) followed by Bonferroni post‐hoc multiple comparison was employed to reveal the difference of IVIM parameters among the investigated brain regions. The linear and the nonlinear polynomial regression analyses were utilized to reveal the correlation between gestational age (GA) and IVIM parameters.

Results

There were significant differences in both D (F(7,623) = 96.64, P = 0.000) and f values (F(7,623) = 2.361, P = 0.0219), but not D* values among the varied brain regions. D values from TWM (r² = 0.1402, P = 0.0002), PWM (r² = 0.2245, P = 0.0002), OWM (r² = 0.2519, P = 0.0002), CH (r² = 0.2245, P = 0.0002), BGR (r² = 0.3393, P = 0.0001), TH (r² = 0.1259, P = 0.0001), and D* value from pons (r² = 0.2206, P = 0.0002) were significantly correlated with GA using linear regression analysis. Quadratic regression analysis led to results similar to those using the linear regression model.

Data Conclusion

IVIM‐DWI parameters may indicate fetal brain developmental alterations but the conclusion is far from reached due to the not as high‐powered correlation between IVIM parameters and GA.

Level of Evidence: 2

Technical Efficacy Stage: 2

J. Magn. Reson. Imaging 2019.

from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader http://bit.ly/2S4uB2r

Fetal brain development at 25–39 weeks gestational age: A preliminary study using intravoxel incoherent motion diffusion‐weighted imaging

Background

The fetal brain developmental changes of water diffusivity and perfusion has not been extensively explored.

Purpose/Hypothesis

To evaluate the fetal brain developmental changes of water diffusivity and perfusion using intravoxel incoherent motion diffusion‐weighted imaging (IVIM‐DWI).

Study Type

Prospective.

Population

Seventy‐nine normal singleton fetuses were scanned without sedation of healthy pregnant women.

Field Strength/Sequence

5 T MRI/T₁/₂‐weighted image and IVIM‐DWI.

Assessment

Pure diffusion coefficient (D), pseudodiffusion coefficient (D*), and perfusion fraction (f) values were calculated in the frontal (FWM), temporal (TWM), parietal (PWM), and occipital white matter (OWM) as well as cerebellar hemisphere (CH), basal ganglia region (BGR), thalamus (TH), and pons using an IVIM model.

Statistical Tests

One‐way analysis of variable (ANOVA) followed by Bonferroni post‐hoc multiple comparison was employed to reveal the difference of IVIM parameters among the investigated brain regions. The linear and the nonlinear polynomial regression analyses were utilized to reveal the correlation between gestational age (GA) and IVIM parameters.

Results

There were significant differences in both D (F(7,623) = 96.64, P = 0.000) and f values (F(7,623) = 2.361, P = 0.0219), but not D* values among the varied brain regions. D values from TWM (r² = 0.1402, P = 0.0002), PWM (r² = 0.2245, P = 0.0002), OWM (r² = 0.2519, P = 0.0002), CH (r² = 0.2245, P = 0.0002), BGR (r² = 0.3393, P = 0.0001), TH (r² = 0.1259, P = 0.0001), and D* value from pons (r² = 0.2206, P = 0.0002) were significantly correlated with GA using linear regression analysis. Quadratic regression analysis led to results similar to those using the linear regression model.

Data Conclusion

IVIM‐DWI parameters may indicate fetal brain developmental alterations but the conclusion is far from reached due to the not as high‐powered correlation between IVIM parameters and GA.

Level of Evidence: 2

Technical Efficacy Stage: 2

J. Magn. Reson. Imaging 2019.

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Correction: Synthesis and antimicrobial photodynamic effect of methylene blue conjugated carbon nanotubes on E. coli and S. aureus

Photochem. Photobiol. Sci., 2019, Advance Article
DOI: 10.1039/C9PP90008J, Correction

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Paramanantham Parasuraman, V. T. Anju, S. B. Sruthil Lal, Alok Sharan, Siddhardha Busi, K. Kaviyarasu, Mohammed Arshad, Turki M. S. Dawoud, Asad Syed
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Correction: Synthesis and antimicrobial photodynamic effect of methylene blue conjugated carbon nanotubes on E. coli and S. aureus

Photochem. Photobiol. Sci., 2019, Advance Article
DOI: 10.1039/C9PP90008J, Correction

Open Access

  This article is licensed under a Creative Commons Attribution 3.0 Unported Licence.

Paramanantham Parasuraman, V. T. Anju, S. B. Sruthil Lal, Alok Sharan, Siddhardha Busi, K. Kaviyarasu, Mohammed Arshad, Turki M. S. Dawoud, Asad Syed
To cite this article before page numbers are assigned, use the DOI form of citation above.
The content of this RSS Feed (c) The Royal Society of Chemistry

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