The aim of the study was to assess disease characteristics and outcome in patients with vertebral osteomyelitis (VO). A two medical centre retrospective cohort study was performed by chart review ...after discharge of 110 patients with confirmed VO treated during a 5-year period. Patients were divided in two groups: patients with uncomplicated VO and patients with complicated VO. All patients underwent clinical and biological examinations and magnetic resonance imaging (MRI) according to the same protocol. Patients with complicated VO were significantly older (p = 0.038). They were longer treated with antibiotics parenterally (p = 0.047) and more often surgically (p < 0.001). In these patients, high Charlson comorbidity index (CCI) score was more often observed (p = 0.024), as well as liver cirrhosis (p = 0.013) and degenerative spine disease (p = 0.007) as comorbidities. Patients with advanced MRI changes of VO had a modified CCI score of 2 or more (p = 0.006). They more often experienced neurological deficit (p = 0.021). Staphylococcus aureus was the most frequently isolated bacterium from blood and tissue samples. Advanced MRI changes and complicated VO were more often observed in patients with high CCI score due to impaired immune system caused by chronic comorbid disease(s) or modulation of immunity with medications. High CCI scores were more frequently associated with positive blood cultures due to bacteremia because of impaired immunity. Patients with complicated VO were longer treated with antibiotics parenterally and more often surgically treated for phlegmon and abscess formation. Liver cirrhosis and degenerative spine disease, which were more often found in patients with complicated VO, obviously impacted the course of the disease.
Internal hernias have an overall incidence of less than 1% and are difficult to diagnose clinically due to their nonspecific presentation. Most internal hernias present as strangulating closed-loop ...obstruction and delay in surgical intervention is responsible for a high mortality rate (49%). We present a case of ileal herniation through the foramen of Winslow. A 29-year-old previously healthy female presented with acute onset right upper quadrant pain, abdominal fullness, and nausea. The pain was sudden in onset and began shortly after a dinner party where she consumed larger portions of food. Laboratory investigations revealed mild leukocytosis with left shift. Dual-phase multi-detector computed tomography disclosed herniation of the small bowel into the lesser sac. The patient underwent an emergency median laparotomy that revealed ileal herniation through the foramen of Winslow. Adhesiolysis and manual reduction of the bowel was performed, and the reduced bowel showed only congestive changes. The postoperative recovery was uneventful and the patient was discharged on the third postoperative day. Risk factors for internal herniation still remain unclear, although excessively mobile bowel loops and an enlarged foramen of Winslow have been described. Our case demonstrated that overeating could be an additional risk factor for internal herniation. We describe our clinical and radiology findings, as well as surgical management. Due to the high rates of morbidity and mortality, it is imperative that clinicians be aware of the possible risks factors for internal herniation. Internal hernias should be included in the differential diagnosis of small bowel obstruction so that appropriate steps can be made in the work-up of these patients, followed by timely surgical intervention.
Cushing’s Disease in a Patient with MEN 2B Syndrome Kruljac, Ivan; Dabelić, Nina; Marjan, Domagoj ...
The American journal of medicine,
February 2020, 2020-02-00, 20200201, Volume:
133, Issue:
2
Journal Article
The purposes of this study were to determine the frequency of diagnosis of atypical ductal hyperplasia (ADH) at MRI-guided 9-gauge vacuum-assisted breast biopsy and to assess the rate of ...underestimation of ADH at subsequent surgical excision.
We conducted a retrospective review of medical records of 237 lesions consecutively detected with MRI and then subjected to MRI-guided 9-gauge vacuum-assisted breast biopsy during a 33-month period. Underestimated ADH was defined as a lesion yielding ADH at vacuum-assisted biopsy and cancer at surgery. Scientific tables were used to calculate 95% CI.
Histologic analysis of MRI-guided vacuum-assisted breast biopsy specimens yielded ADH without cancer in 15 (6%) of 237 lesions. Among 15 patients in whom vacuum-assisted breast biopsy yielded ADH, the median age was 52 years (range, 46-68 years). The median number of specimens obtained was nine (range, 8-18 lesions). Median MRI lesion diameter was 1.3 cm (range, 0.7-7.0 cm). Among 15 MRI lesions, 10 (67%) were nonmasslike enhancement and five (33%) were masses. Surgical excision was performed on 13 lesions. Surgical histologic findings were malignancy in five (38%) of the cases, all ductal carcinoma in situ; high-risk lesion in six (46%) of the cases, including ADH without other high-risk lesions (n = 2), ADH and lobular carcinoma in situ (LCIS) (n = 1), ADH, LCIS, and papilloma (n =1), ADH and papilloma (n = 1), and LCIS (n = 1); and benign in two (15%) of the cases. These data indicated an ADH underestimation rate of 38% (95% CI, 14-68%).
ADH without cancer was encountered in 6% of MRI-guided 9-gauge vacuum-assisted breast biopsies. ADH at MRI-guided vacuum-assisted breast biopsy is an indication for surgical excision because of the high (38%) frequency of underestimation of these lesions.
We describe a case of a spinal subdural metastatic tumor that became rapidly symptomatic after a minor trauma, as a result of severe cord compression and cord hemorrhage. On MR imaging, the lesion ...was oval, hyperintense with a dark rim on T2-weighted fast spin-echo images, isointense to the cord on T1-weighted images, and had dark and bright areas on gradient-echo T2*-weighted images, consistent with a hyperacute-to-acute hematoma. The hemorrhagic tumor showed no evidence of contrast enhancement.
The purpose of the study was to determine the difference in extrahepatic bile duct (EBD) size measured by magnetic resonance (MR) compared with those measured by ultrasound (US). Changes of EBD size ...related to aging were analyzed too. Size of EBD was measured in 76 randomly selected healthy individuals. Three radiologists blinded to the result of other study preformed measurements by US and three different T2 weighted MR sequences. Correlation and linear regression analysis of obtained data were performed. The mean diameter of EBD measured by US was 3.17 mm and by MR was 3.14 mm on thick slab rapid acquisition with relaxation enhancement (TSE), 3.26 mm on thin section single-shot TSE (HASTE) and 3.30 mm on coronal fully rewound gradient echo (True FISP). There was no statistical difference between US and different MR sequences (p < 0.05). A trend of increase of EBD with age (0.0155 mm per year, p = 0.0954) was observed. Size of EBD highly correlated for each MR sequence with US measurement validating use of MR as a reliable method for evaluation of EBD size. This conclusion is stressed by increase of EBD size with age demonstrated by all measuring methods.
Ciljevi istraživanja su bili prikazati karakteristike i ishod vertebralnog osteomijelitisa (VO) u odraslih bolesnika. Radi se o retrospektivnoj studiji u koju je bilo uključeno 110 bolesnika s VO ...koji su hospitalizirani u petogodišnjem razdoblju. Bolesnici su podijeljeni u skupinu s nekompliciranim i skupinu s kompliciranim VO. Svi bolesnici su imali nalaze laboratorijskih pretraga i MR pregled kralježnice. Bolesnici s kompliciranim VO su bili značajno stariji (p=0,038), duže su parenteralno liječeni antibioticima (p=0,047) i češće su kirurški liječeni (p<0,001). U istih bolesnika su češće bili zastupljeni viši stupanj komorbiditeta po Charlsonu (engl. Charlson comorbidity index score, CCI score) (p=0,024), ciroza jetre (p=0,013) i degenerativna bolest kralježnice (p=0,007) za razliku od bolesnika s nekompliciranim VO. Bolesnici s uznapredovalim MR promjenama su češće imali viši zbir CCI, 2 ili više (p=0,006) te učestalije neurološke ispade (p=0,021). Staphylococcus aureus je najčešće izolirana bakterija iz krvi i tkiva. Uznapredovale MR promjene i komplicirani VO su češće bili zastupljeni u bolesnika koji su imali viši zbir CCI, najvjerojatnije zbog oštećenja imunog sustava uslijed komorbiditeta ili promjene imunog odgovora lijekovima. Viši zbir CCI je češće bio udružen s pozitivnim hemokulturama uslijed bakterijemije zbog oštećenja imuniteta. Bolesnici s kompliciranim VO su duže parenteralno liječeni antibioticima zbog učestalijih flegmona ili apscesa. Ciroza jetre i degenerativna bolest kralježnice koji su kao komorbiditeti bili učestaliji u bolesnika s kompliciranim VO najvjerojatnije su utjecali na tijek bolesti.
Ukupna incidencija unutarnjih hernija manja je od 1%, a zbog njihove nespecifične prezentacije otežano je postavljanje kliničke dijagnoze. Većina unutarnjih hernija prezentira se kao strangulirajuće ...opstrukcije zatvorene petlje, a nepravodobna kirurška intervencija odgovorna je za visoku stopu smrtnosti (49%). U našem radu predstavljamo slučaj ilealne hernijacije kroz foramen Winslow. Dvadesetdevetgodišnja prethodno zdrava žena primljena je zbog akutnog nastupa boli locirane u desnom gornjem trbušnom kvadrantu praćene mučninom i osjećajem nadutosti. Bol je nastupila iznenadno,
nedugo nakon večere gdje je konzumirala veću količinu hrane. Laboratorijske pretrage pokazale su blagu leukocitozu sa skretanjem ulijevo. Nativnim abdomenom vizualizirani su aerolikvidni nivoi, a višeslojnom kompjutorskom tomografijom prikazana je hernijacija tankog crijeva u omentalnu bursu. Bolesnica je podvrguta hitnoj medijanoj laparotomiji kojom je vizualizirana ilealna hernijacija kroz foramen Winslow. Odstranjene su priraslice s tankoga crijeva koje je pokazivalo promjene kongestivnog tipa. Poslijeoperacijski tijek protekao je uredno te je bolesnica otpuštena kući trećeg dana poslije
operacije. Međutim, čimbenici rizika za unutarnje hernijacije još uvijek ostaju nepoznati. Neki od mogućih čimbenika rizika su povećana mobilnost crijevnih vijuga i povećan foramen Winslow. Naš slučaj pokazuje da i prejedanje može biti potencijalni dodatni rizični čimbenik za unutarnje hernijacije. U radu prikazujemo kliničke i radiološke pokazatelje, kao i samu kiruršku intervenciju. Zbog visoke stope pobola i smrtnosti veoma je važno da liječnici budu svjesni mogućih rizičnih čimbenika za pojavu unutarnje hernijacije. U diferencijalnu dijagnostiku opstrukcija tankog crijeva svakako bi trebalo uključiti i unutarnje hernije kako bi se mogle provesti odgovarajuće mjere pri obradi bolesnika te pravodobna kirurška
intervencija.
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