Blindness after facial trauma: epidemiology, incidence and risk factors. a 27-year cohort study of 5708 patients.

Publication date: Available online 23 March 2018
Source:Oral Surgery, Oral Medicine, Oral Pathology and Oral Radiology
Author(s): Panagiotis Stathopoulos, Dimosthenis Igoumenakis, Michalis Mezitis, George Rallis
ObjectivesThis is a 27-year study of a cohort of 5708 patients who sustained maxillofacial fractures. Our purpose is to present the aetiology, mechanism of trauma, site and concomitant injuries that led to visual loss. We hypothesize that fractures caused by high energy impact of the midface may be associated with blindness. A discussion of the treatment approaches is also included.Study Design5708 patients sustained a maxillofacial fracture during the years from 1985 to 2012 and were included in this study. Patients' records were reviewed for gender, age, fracture site, aetiology of trauma, concomitant injuries, method of treatment, length of hospital stay and cause of blindness. The relation of the above variables to blindness was investigated.ResultsThe incidence of loss of vision was 0.34%. A very strong association between firearm injuries and blindness is demonstrated. (p<0.001) These patients spent much longer time in hospital (p<0.01) and suffered serious concomitant injuries involving the brain.ConclusionRetrobullbar haemorrhage should be treated with lateral canthotomy whereas in traumatic optic neuropathy, observation seems to be the safest thing to do. In patients with penetrating injuries of the globe the immediate involvement of an Ophthalmic Surgeon is of paramount importance.



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Demographics and referral patterns of a university-based oral maxillofacial radiology clinic over a 20 year period

Publication date: Available online 23 March 2018
Source:Oral Surgery, Oral Medicine, Oral Pathology and Oral Radiology
Author(s): Chen Nadler, Linda Lee
Objectives– The aim of this study was to review the referral patterns, distribution of interpretations, and type of diagnostic imaging used in a university based oral maxillofacial radiology clinic for patients referred for consultation from both dental and non-dental clinicians.Study Design– The database of the Special Procedures clinic in the Oral Radiology department of the University of Toronto, Faculty of Dentistry, containing over 5,000 entries, from 1993 to 2013, was queried. Using descriptive categorical analysis, the results were analyzed to describe patient demographics, the speciality of the referring clinicians, the imaging modalities used and the interpretation provided.Results– Most referrals were from oral and maxillofacial surgeons and general dentists. Approximately 25% of referrals were interpreted as variations of normal anatomic structures. The most common reasons for referral were intraosseous lesions (42%), temporomandibular joints (39%), and sialography. Ten per cent of all referrals were for recall examinations. The distribution of image modalities has changed through the years covered by this study.Conclusion– This study reflects a lower proportion of referrals reported as normal structures and their variations, than reported in a previous comparable study.



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Intrathecal gadolinium-enhanced MR cisternography in patients with otorhinorrhea: 10-year experience of a tertiary referral center

Abstract

Purpose

Despite a considerable amount of literature that has been published about the use of intrathecal gadolinium-enhanced MR cisternography (IGE-MRC), there is still relatively lack of evidence as to its long-term effects. Our purpose in this study was twofold: firstly, to assess the long-term safety of the IGE-MRC; secondly, to evaluate the diagnostic performance of IGE-MRC for detecting cerebrospinal fluid (CSF) leak in otorhinorrhea patients.

Methods

We retrospectively reviewed our imaging and clinical database for the patients admitted to our department for the evaluation of their otorhinorrhea between 2008 and 2017. Two radiologists evaluated the imaging studies independently. Consensus data was used in the analysis. Medical record review and phone call were used for the long-term follow-up.

Results

The retrospective review yielded 166 patients. Rhinorrhea was present in 150 (90.4%) patients and otorrhea in 16 (9.6%) patients. Overall, 67 patients (40.5% of all patients) underwent operation for repair of the CSF leak site. Beta-transferrin test was available and positive in 57 (34.3%) patients. Overall sensitivity of IGE-MRC and paranasal high-resolution CT (HRCT) was 89.3 and 72%, respectively. Within the first 24 h after the procedure, none of the patients experienced a significant complication or adverse reaction. Ninety-nine patients (59.6%) had medical record and telephone follow-up. The mean follow-up duration with call was 37.1 months. Three (3%) patients complained about severe headache 3–4 weeks after the procedure.

Conclusions

IGE-MRC is a minimally invasive and highly sensitive imaging technique. No adverse side effect during our long-term follow-up might strengthen and support the safety of IGE-MRC.

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Risk factor analysis of recanalization and retreatment for patients with endovascular treatment of internal carotid artery bifurcation aneurysms

Abstract

Purpose

Only a few reports of internal carotid artery (ICA) bifurcation aneurysms using the endovascular technique have been published in the current literature. The purpose of this study was to assess how multiple risk factors including angioarchitectural features of ICA bifurcation characteristics may have influenced aneurysmal rupture, recanalization, and retreatment.

Methods

Fifty-one patients with 52 ICA bifurcation aneurysms treated with endovascular coiling between July 2003 and July 2015 were retrospectively analyzed. The patients' clinical records, endovascular reports, and clinical and angiographic outcomes were reviewed. We also evaluated risk factors for recanalization and retreatment, including the angioarchitectural anatomy.

Results

The clinical outcomes were observed to be satisfactory in 49 patients (96.0%) and unfavorable in 2 patients (4.0%). The risk factor for aneurysmal rupture was young age (P = 0.024). Symptomatic complications due to thromboembolism occurred in 1.9% of cases; no patients suffered a fatal complication. Eleven of 52 ICA bifurcation aneurysms (21.2%) were recanalized within an average of 54.3 ± 33.5 months of follow-up. Among the aneurysms, 4 (7.7%) underwent recoiling. Multivariate analysis showed that ruptured aneurysms (P = 0.006) and a lower packing density (P = 0.048) were risk factors for recanalization. A lower packing density was the only risk factor for retreatment (P = 0.019).

Conclusion

Endovascular treatment of ICA bifurcation aneurysms is considered safe and acceptable. This study showed that the ICA bifurcation aneurysms ruptured more frequently at a younger age. A higher packing density has been shown to reduce major recanalization and retreatment.

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Intrathecal gadolinium-enhanced MR cisternography in patients with otorhinorrhea: 10-year experience of a tertiary referral center

Abstract

Purpose

Despite a considerable amount of literature that has been published about the use of intrathecal gadolinium-enhanced MR cisternography (IGE-MRC), there is still relatively lack of evidence as to its long-term effects. Our purpose in this study was twofold: firstly, to assess the long-term safety of the IGE-MRC; secondly, to evaluate the diagnostic performance of IGE-MRC for detecting cerebrospinal fluid (CSF) leak in otorhinorrhea patients.

Methods

We retrospectively reviewed our imaging and clinical database for the patients admitted to our department for the evaluation of their otorhinorrhea between 2008 and 2017. Two radiologists evaluated the imaging studies independently. Consensus data was used in the analysis. Medical record review and phone call were used for the long-term follow-up.

Results

The retrospective review yielded 166 patients. Rhinorrhea was present in 150 (90.4%) patients and otorrhea in 16 (9.6%) patients. Overall, 67 patients (40.5% of all patients) underwent operation for repair of the CSF leak site. Beta-transferrin test was available and positive in 57 (34.3%) patients. Overall sensitivity of IGE-MRC and paranasal high-resolution CT (HRCT) was 89.3 and 72%, respectively. Within the first 24 h after the procedure, none of the patients experienced a significant complication or adverse reaction. Ninety-nine patients (59.6%) had medical record and telephone follow-up. The mean follow-up duration with call was 37.1 months. Three (3%) patients complained about severe headache 3–4 weeks after the procedure.

Conclusions

IGE-MRC is a minimally invasive and highly sensitive imaging technique. No adverse side effect during our long-term follow-up might strengthen and support the safety of IGE-MRC.

from Imaging via alkiviadis.1961 on Inoreader https://ift.tt/2pCvq2f

Risk factor analysis of recanalization and retreatment for patients with endovascular treatment of internal carotid artery bifurcation aneurysms

Abstract

Purpose

Only a few reports of internal carotid artery (ICA) bifurcation aneurysms using the endovascular technique have been published in the current literature. The purpose of this study was to assess how multiple risk factors including angioarchitectural features of ICA bifurcation characteristics may have influenced aneurysmal rupture, recanalization, and retreatment.

Methods

Fifty-one patients with 52 ICA bifurcation aneurysms treated with endovascular coiling between July 2003 and July 2015 were retrospectively analyzed. The patients' clinical records, endovascular reports, and clinical and angiographic outcomes were reviewed. We also evaluated risk factors for recanalization and retreatment, including the angioarchitectural anatomy.

Results

The clinical outcomes were observed to be satisfactory in 49 patients (96.0%) and unfavorable in 2 patients (4.0%). The risk factor for aneurysmal rupture was young age (P = 0.024). Symptomatic complications due to thromboembolism occurred in 1.9% of cases; no patients suffered a fatal complication. Eleven of 52 ICA bifurcation aneurysms (21.2%) were recanalized within an average of 54.3 ± 33.5 months of follow-up. Among the aneurysms, 4 (7.7%) underwent recoiling. Multivariate analysis showed that ruptured aneurysms (P = 0.006) and a lower packing density (P = 0.048) were risk factors for recanalization. A lower packing density was the only risk factor for retreatment (P = 0.019).

Conclusion

Endovascular treatment of ICA bifurcation aneurysms is considered safe and acceptable. This study showed that the ICA bifurcation aneurysms ruptured more frequently at a younger age. A higher packing density has been shown to reduce major recanalization and retreatment.

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Cerebral Perforating Artery Disease

Abstract

Purpose

Our aims were to evaluate the feasibility of high-resolution magnetic resonance imaging (HR-MRI) for displaying the cerebral perforating arteries in normal subjects and to discuss the value of HR-MRI for detecting the causes of infarctions in the territory of the lenticulostriate artery (LSA).

Methods

Included in this study were 31 healthy subjects and 28 patients who had infarctions in the territory supplied by the LSA. The T1-weighted imaging (T1WI), T2WI, diffusion-weighted imaging (DWI), and HR-MRI, including 3‑dimensional time-of-flight magnetic resonance angiography (3D-TOF-MRA) and 3D fast spin-echo T1WI (namely CUBE T1 in GE Healthcare), were applied on a 3-Tesla scanner. The numbers and route of the perforating arteries on both sides were independently confirmed on HR-MRI by two physicians. The Wilcoxon test was used to compare the differences.

Results

The numbers of perforating arteries in healthy subjects observed on 3D-TOF-MRA were as follows: numbers of the bilateral recurrent artery of Heubner (RAH) ranged from 0–3 (median 1), numbers of the left LSA ranged from 0–7 (median 3), numbers of the right LSA ranged from 0–5 (median 3), numbers of the bilateral anterior choroidal artery ranged from 1–2 (median 1) and the numbers of the bilateral thalamoperforating artery ranged from 1–2 (median 1). In the patients with lenticulostriate infarctions, the numbers of LSAs on the affected side were lower than on the opposite and ipsilateral sides in the healthy subjects. The results were statistically significant. An abnormality of the RAH may lead to a centrum semiovale infarct pattern, whereas an abnormality of the LSA is associated with a corona radiata infarct pattern.

Conclusion

The use of HR 3D-TOF-MRA and CUBE T1 had unique advantages in displaying the tiny perforating arteries in vivo. Moreover, effective recognition of the associated cerebral perforating artery and infarct patterns may enhance our understanding of the mechanism of stroke in patients with lenticulostriate infarctions.

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Location and causation of residual lymph node metastasis after surgical treatment of regionally advanced differentiated thyroid cancer.

Location and causation of residual lymph node metastasis after surgical treatment of regionally advanced differentiated thyroid cancer.

Thyroid. 2018 Mar 21;:

Authors: Miller JE, Al-Attar NC, Brown OH, Shaughness GG, Rosculet NP, Avram A, Hughes DT

Abstract
BACKGROUND: After initial surgical treatment of differentiated thyroid cancer (DTC) residual lymph node metastases are often found at the time of radioactive iodine (131-I) therapy. Recurrence of DTC is due to persistent disease not removed at initial surgery and that did not respond to 131-I treatment. This study aims to determine locations of, and reasons for, residual nodal metastases detected by 131-I scans with SPECT/CT obtained prior to radioiodine therapy following surgical treatment of DTC.
METHODS: This is a retrospective study of 352 patients with intermediate and high-risk DTC treated with 131-I therapy at the University of Michigan from 2007-2014. All patients underwent total thyroidectomy with or without lymph node dissection followed by radioiodine therapy. Pre-ablation diagnostic 131-I scans with SPECT/CT were used postoperatively to localize nodal metastases, which were then compared with the cervical lymph node basins dissected at the time of surgery to determine the reason for residual nodal metastases: incomplete nodal dissection versus preoperative unrecognized nodal metastases.
RESULTS: 146/352 (41.5%) patients had residual nodal metastases detected on 131-I scans with SPECT/CT following initial surgery, but prior to 131-I therapy. Among the 146 patients with residual disease, there were a total of 218 distinct nodal metastases. Relative to the primary tumor, 71.6% (n=156) of metastases were ipsilateral, 22.0% (n=48) were contralateral, and 6.4% (n=14) were non-sided in the central neck (level VI/VII). Cervical lymph node levels VI, III, and II had the greatest frequencies of residual metastases (33.9%, 22.9%, 18.8%, respectively). Residual metastases occurred because of incomplete nodal dissection (49.3%), lack of preoperative identification (37.7%), or a combination of both (13%).
CONCLUSION: Residual nodal metastasis following initial surgical treatment for regionally advanced differentiated thyroid cancer is rather common on highly sensitive 131-I scans with SPECT/CT and is due to both unrecognized nodal involvement preoperatively and incomplete removal of metastatic lymph nodes during compartment-orientated nodal dissection. The surgical management of high-risk DTC should include preoperative imaging to evaluate for nodal metastases in the central and lateral neck and compartment-orientated nodal dissection of involved compartments. Attention should be given to complete dissection in levels VI, III, and II, particularly when dissecting compartments ipsilateral to the primary tumor.

PMID: 29562827 [PubMed - as supplied by publisher]

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Bildgebung gastrointestinaler Entzündungen

Zusammenfassung

Klinisches Problem

Pathologische Veränderungen der Wand des Gastrointestinaltrakts können durch eine Vielzahl entzündlicher, infektiöser, neoplastischer oder ischämischer Ursachen bedingt sein.

Radiologische Standardverfahren

Moderne Schnittbildverfahren haben konventionelle Durchleuchtungsuntersuchungen wie die Doppelkontrast-Enterographie oder den Kolonkontrasteinlauf weitgehend abgelöst und durch die Möglichkeit einer raschen, genauen und minimal-invasiven Diagnostik wachsende Bedeutung in der Diagnostik entzündlicher Darmerkrankungen erlangt. Die Distension des Lumens mit neutralem, oral verabreichtem Kontrastmittel (KM) verbessert die Beurteilbarkeit der gesamten Darmwand. Darüber hinaus ist auch die Beurteilung extraintestinaler Strukturen und Organe möglich.

Methodische Innovationen und Bewertung

Durch zunehmende technische Fortschritte können die Darmwandveränderungen in der Computertomographie (CT) und der Magnetresonanztomographie (MRT) genauer charakterisiert werden. Ein strukturierter Zugang mit Analyse der radiologischen Zeichen und Muster sowie der Assoziation mit extraintestinalen Auffälligkeiten hilft bei der genaueren Zuordnung zu spezifischen Krankheitsgruppen.

Empfehlung für die Praxis

In diesem Artikel werden die häufigsten Zeichen und Muster angeführt, die bei entzündlichen Veränderungen des Gastrointestinaltrakts gefunden werden. Praktische Tipps für die systematische Befundanalyse sowie häufige Fehlermöglichkeiten sollen bei der korrekten Interpretation und Eingrenzung der Differenzialdiagnosen helfen.

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