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https://www.readbyqxmd.com/read/27927829/lesson-of-the-month-1-lobar-pulmonary-consolidation-in-an-immunocompromised-host
#1
Daniel J Reynolds, Carl A Andersen, Sumedh S Hoskote, Hee Eun Lee, Aditya Raghunathan, Sanjay Kalra, Andrew H Limper
A 19-year-old male with a history of idiopathic panuveitis, currently taking methotrexate and infliximab, presented to our institution with 6 weeks of cough, dyspnoea and fevers. He had failed outpatient antimicrobial therapy. Computerised tomography (CT) of the chest revealed the presence of a lobar pneumonia and he was treated with broad spectrum antibiotics, which did not improve his symptoms. Bronchoalveolar lavage was performed with a transbronchial lung biopsy because of the diagnostic uncertainty of the patient's presentation...
December 2016: Clinical Medicine: Journal of the Royal College of Physicians of London
https://www.readbyqxmd.com/read/27923390/the-rapid-ctca-trial-rapid-assessment-of-potential-ischaemic-heart-disease-with-ctca-a-multicentre-parallel-group-randomised-trial-to-compare-early-computerised-tomography-coronary-angiography-versus-standard-care-in-patients-presenting-with-suspected-or-confirmed
#2
Alasdair J Gray, Carl Roobottom, Jason E Smith, Steve Goodacre, Katherine Oatey, Rachel O'Brien, Robert F Storey, Lumine Na, Steff C Lewis, Praveen Thokala, David E Newby
BACKGROUND: Emergency department attendances with chest pain requiring assessment for acute coronary syndrome (ACS) are a major global health issue. Standard assessment includes history, examination, electrocardiogram (ECG) and serial troponin testing. Computerised tomography coronary angiography (CTCA) enables additional anatomical assessment of patients for coronary artery disease (CAD) but has only been studied in very low-risk patients. This trial aims to investigate the effect of early CTCA upon interventions, event rates and health care costs in patients with suspected/confirmed ACS who are at intermediate risk...
December 7, 2016: Trials
https://www.readbyqxmd.com/read/27886714/classification-of-ct-brain-images-based-on-deep-learning-networks
#3
Xiaohong W Gao, Rui Hui, Zengmin Tian
While computerised tomography (CT) may have been the first imaging tool to study human brain, it has not yet been implemented into clinical decision making process for diagnosis of Alzheimer's disease (AD). On the other hand, with the nature of being prevalent, inexpensive and non-invasive, CT does present diagnostic features of AD to a great extent. This study explores the significance and impact on the application of the burgeoning deep learning techniques to the task of classification of CT brain images, in particular utilising convolutional neural network (CNN), aiming at providing supplementary information for the early diagnosis of Alzheimer's disease...
January 2017: Computer Methods and Programs in Biomedicine
https://www.readbyqxmd.com/read/27884851/influence-of-preinfarction-angina-and-coronary-collateral-blood-flow-on-the-efficacy-of-remote-ischaemic-conditioning-in-patients-with-st-segment-elevation-myocardial-infarction-post-hoc-subgroup-analysis-of-a-randomised-controlled-trial
#4
Kasper Pryds, Morten Bøttcher, Astrid Drivsholm Sloth, Kim Munk, Michael Rahbek Schmidt, Hans Erik Bøtker
OBJECTIVES: Remote ischaemic conditioning (RIC) confers cardioprotection in patients with ST segment elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention (pPCI). We investigated whether preinfarction angina and coronary collateral blood flow (CCBF) to the infarct-related artery modify the efficacy of RIC. DESIGN: Post hoc subgroup analysis of a randomised controlled trial. PARTICIPANTS: A total of 139 patients with STEMI randomised to treatment with pPCI or RIC+pPCI...
November 24, 2016: BMJ Open
https://www.readbyqxmd.com/read/27874166/-massive-cerebral-air-embolism-following-endoscopic-retrograde-cholangiopancreatography-a-case-report-and-review-of-the-literature
#5
J Fernandez-Fernandez, H Real-Noval, E Rodriguez-Rodriguez
INTRODUCTION: Cerebral air embolism following endoscopic processes is an infrequent complication, but can have catastrophic consequences. CASE REPORT: An 85-year-old male diagnosed with distal cholangiocarcinoma with criteria for unresectability who was submitted to placement of a biliary drainage prosthesis. Endoscopic retrograde cholangiopancreatography was performed to change the prosthesis. After the procedure, the patient's vital signs and level of consciousness underwent a decline, and orotracheal intubation was required...
December 1, 2016: Revista de Neurologia
https://www.readbyqxmd.com/read/27867440/an-unusual-case-of-a-metallic-foreign-body-per-urethra
#6
Haresh G Thummar, Hemen I Vithlani, Pokhraj P Suthar, Deepa Regina John, Nisha Thummar, Harendra Chauhan
BACKGROUND: Foreign body in the lower urinary tract has a low incidence. Here we discuss a case of a safety pin within the bulbar urethra inserted by a young boy for sexual gratification, which was successfully removed under cysto-urethroscopic guidance. CASE REPORT: Herein we present a case of a 14-year-old boy who presented with complaints of perineal pain and dysuria. On evaluation in detail and from clinical history, we came to know that he had inserted a safety pin within the urethra...
2016: Polish Journal of Radiology
https://www.readbyqxmd.com/read/27845941/magnetic-resonance-elastography-mre-of-the-human-brain-technique-findings-and-clinical-applications
#7
Lucy V Hiscox, Curtis L Johnson, Eric Barnhill, Matt D J McGarry, John Huston, Edwin J R van Beek, John M Starr, Neil Roberts
Neurological disorders are one of the most important public health concerns in developed countries. Established brain imaging techniques such as magnetic resonance imaging (MRI) and x-ray computerised tomography (CT) have been essential in the identification and diagnosis of a wide range of disorders, although usually are insufficient in sensitivity for detecting subtle pathological alterations to the brain prior to the onset of clinical symptoms-at a time when prognosis for treatment is more favourable. The mechanical properties of biological tissue provide information related to the strength and integrity of the cellular microstructure...
December 21, 2016: Physics in Medicine and Biology
https://www.readbyqxmd.com/read/27836784/-clinical-observation-a-safe-alternative-to-radiology-in-infants-with-mild-traumatic-brain-injury
#8
David Muñoz-Santanach, Victoria Trenchs Sainz de la Maza, Sara Maya Gallego, Adriana Cuaresma González, Carles Luaces Cubells
OBJECTIVE: The protocol for the management of mild cranioencephalic trauma in the emergency department was changed in July 2013. The principal innovation was the replacement of systematic X-ray in infants with clinical observation. The aims of this study were to determine whether there was, 1) a reduction in the ability to detect traumatic brain injury (TBI) in the initial visit to Emergency, and 2) a change in the number of requests for imaging tests and hospital admissions. METHODOLOGY: This was a retrospective, descriptive, observational study...
November 8, 2016: Anales de Pediatría: Publicación Oficial de la Asociación Española de Pediatría (A.E.P.)
https://www.readbyqxmd.com/read/27832558/a-comparative-study-of-tracheal-diameter-in-caucasian-and-chinese-patients
#9
A Tai, C Corke, G M Joynt, J Griffith, D Lunn, Pwy Tong
Ethnicity may be considered a factor when considering what size endotracheal tube to insert. In particular it has been suggested that Chinese patients have a smaller tracheal diameter, justifying the selection of smaller endotracheal tubes. We systematically evaluated transverse tracheal diameters in Chinese and Caucasian patients, utilising archived computer tomography images. A convenience sample of 100 Caucasian patients from Australia was compared with 100 Chinese patients from Hong Kong. Patients over 18 years of age who had undergone a computerised tomography scan of the neck and thorax, and also had accurate body height and weight recorded, were studied...
November 2016: Anaesthesia and Intensive Care
https://www.readbyqxmd.com/read/27805791/a-double-blind-randomised-controlled-trial-of-collagen-mesh-for-the-prevention-of-abdominal-incisional-hernia-in-patients-having-a-vertical-rectus-abdominis-myocutaneus-vram-flap-during-surgery-for-advanced-pelvic-malignancy
#10
Alexander Risskov Mortensen, Irene Grossmann, Mona Rosenkilde, Pål Wara, Søren Laurberg, Peter Christensen
AIM: The study investigated the effect of collagen mesh-assisted closure at the donor site in preventating the formation of incisional hernia following a vertical rectus abdominis myocutaneus (VRAM) flap as part of pelvic surgery for recurrent colorectal cancer.. METHOD: The study was a double blinded randomised controlled superiority trial performed designed according to the Consort Statement. Eligible patients undergoing surgery for advanced colorectal pelvic malignancy including a VRAM flap were prospectively randomised to conventional abdominal wound closure or collagen mesh-assisted closure...
November 2, 2016: Colorectal Disease: the Official Journal of the Association of Coloproctology of Great Britain and Ireland
https://www.readbyqxmd.com/read/27790514/intra-luminal-metastasis-to-duodenum-a-histological-surprise
#11
Kaushik Subramanian, Tirou Aroul, Sasikumar Kuppusamy, Vijay Gunashekaran
Carcinoma cervix is one of the most common malignancies seen in women worldwide and more so in the Indian subcontinent. Carcinoma cervix is known for its orderly lymphatic spread. Skip metastasis or intraluminal metastasis is not a frequent occurrence. A 50-year-old diabetic and hypertensive female patient who was diagnosed to have carcinoma cervix (stage II A 2) Grade II to III and post radiotherapy (3 years back) presented to the surgical outpatient with dyspeptic symptoms and vague abdominal pain. On examination she was found to have a 1x1cm hard, fixed, left supraclavicular node and a palpable liver...
September 2016: Journal of Clinical and Diagnostic Research: JCDR
https://www.readbyqxmd.com/read/27782768/extrastriatal-dopamine-d2-3-receptors-and-cortical-grey-matter-volumes-in-antipsychotic-na%C3%A3-ve-schizophrenia-patients-before-and-after-initial-antipsychotic-treatment
#12
Henrik Nørbak-Emig, Lars H Pinborg, Jayachandra M Raghava, Claus Svarer, William F C Baaré, Peter Allerup, Lars Friberg, Egill Rostrup, Birte Glenthøj, Bjørn H Ebdrup
OBJECTIVES: Long-term dopamine D2/3 receptor blockade, common to all antipsychotics, may underlie progressive brain volume changes observed in patients with chronic schizophrenia. In the present study, we examined associations between cortical volume changes and extrastriatal dopamine D2/3 receptor binding potentials (BPND) in first-episode schizophrenia patents at baseline and after antipsychotic treatment. METHODS: Twenty-two initially antipsychotic-naïve patients underwent magnetic resonance imaging (MRI), [(123)I]epidepride single-photon emission computerised tomography (SPECT), and psychopathology assessments before and after 3 months of treatment with either risperidone (N = 13) or zuclopenthixol (N = 9)...
October 26, 2016: World Journal of Biological Psychiatry
https://www.readbyqxmd.com/read/27776379/-unknown-title
#13
M Kadihasanoglu, M Kilciler, O Atahan
A 44-year-old woman, who had had left flank pain for the previous 3 months, was treated successfully for renal hydatid cyst disease by using an endoscopic technique with percutaneous access through an all seeing needle. Abdominal ultrasonography showed a Gharbi type III cyst in the lower pole of the left kidney. Computerised tomography of the abdomen revealed a bulky solid-cystic mass with calcified and well-defined wall and daughter cyst without contrast enhancement. The patient, who refused any renal operation, underwent a percutaneous intervention with access through an all seeing needle access...
October 24, 2016: Aktuelle Urologie
https://www.readbyqxmd.com/read/27724913/ct-screened-arterial-calcification-as-a-risk-factor-for-mortality-after-trauma
#14
Henry D De'Ath, Kathryn Oakland, Karim Brohi
BACKGROUND: Arterial calcification on Computerised Tomography (CT) is a marker of cardiovascular disease. It is predictive of future adverse cardiac events and mortality in many disease states. The incidence of arterial disease and its impact on outcomes of the injured is not known. The objectives of this study were to describe the incidence of arterial calcification in trauma patients, and establish its impact on mortality. METHODS: A retrospective cohort study of all injured patients aged over 45 years presenting to a major trauma centre over a 34-month period...
October 10, 2016: Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine
https://www.readbyqxmd.com/read/27699459/description-and-reproducibility-assessment-of-a-new-computerised-tomography-scan-index-to-measure-the-glenoid-orientation-in-relation-to-the-anterior-glenoid-surface
#15
Constantina Moraiti, Shahnaz Klouche, Jean David Werthel, Thomas Bauer, Philippe Hardy
PURPOSE: To propose and to assess the reproducibility of a new method (GO [glenoid orientation] index) for the estimation of the glenoid orientation in relation to the anterior surface of the glenoid. METHODS: This is a retrospective study on computed tomography (CT) scan. The GO index was defined as the angle formed by a line perpendicular to the tangent to the anterior surface of the scapula and the glenoid line (which is defined as the line connecting the anterior and the posterior rim of the glenoid)...
October 4, 2016: International Orthopaedics
https://www.readbyqxmd.com/read/27666113/congenital-cystic-adenomatoid-malformation-of-the-lung-ccam-a-retrospective-clinical-audit-and-literature-review-in-a-tertiary-centre-in-scotland-over-a-period-of-14-years
#16
Ambrin Gull Shamas, Karishma Bohara
This work was a retrospective audit of CCAM - 1994 to 2008. A total of 26 cases were identified. Mean gestational age at diagnosis was 20 weeks. All were unilateral and had serial scans. In 31% the lesion resolved, 8% decreased, 42% were unchanged and 4% increased in size. Only one foetus developed hydrops. All were born alive. Of 8 foetuses where the CCAM was thought to have resolved, 6 had persistent lesions (overall sensitivity and PPV of US 64% and 69%, respectively). Computerised tomography performed better than chest X-ray in detecting lesions postnatally (sensitivity 100% vs 88%, PPV 95% vs 78%)...
September 25, 2016: Journal of Obstetrics and Gynaecology: the Journal of the Institute of Obstetrics and Gynaecology
https://www.readbyqxmd.com/read/27664415/abnormal-vocal-cord-movement-in-patients-with-and-without-airway-obstruction-and-asthma-symptoms
#17
Kathy Low, Laurence Ruane, Nizam Uddin, Paul Finlay, Kenneth K Lau, Kais Hamza, Peter W Holmes, Garun Hamilton, Philip G Bardin
BACKGROUND: Abnormal vocal cord movements can cause laryngeal extrathoracic airway obstruction (often called vocal cord dysfunction - VCD) leading to asthma-like symptoms. These aberrant movements are characteristically present during inspiration and termed paradoxical vocal cord movement (PVCM). We have reported PVCM in up to 40% of severe asthmatics but it is not known if PVCM is detectable in all patients with asthma-like symptoms and if the condition is more often associated with abnormal lung function...
September 24, 2016: Clinical and Experimental Allergy: Journal of the British Society for Allergy and Clinical Immunology
https://www.readbyqxmd.com/read/27651515/variations-in-gps-decisions-to-investigate-suspected-lung-cancer-a-factorial-experiment-using-multimedia-vignettes
#18
Jessica Sheringham, Rachel Sequeira, Jonathan Myles, William Hamilton, Joe McDonnell, Judith Offman, Stephen Duffy, Rosalind Raine
INTRODUCTION: Lung cancer survival is low and comparatively poor in the UK. Patients with symptoms suggestive of lung cancer commonly consult primary care, but it is unclear how general practitioners (GPs) distinguish which patients require further investigation. This study examined how patients' clinical and sociodemographic characteristics influence GPs' decisions to initiate lung cancer investigations. METHODS: A factorial experiment was conducted among a national sample of 227 English GPs using vignettes presented as simulated consultations...
September 20, 2016: BMJ Quality & Safety
https://www.readbyqxmd.com/read/27634489/hughes-abdominal-repair-trial-hart-abdominal-wall-closure-techniques-to-reduce-the-incidence-of-incisional-hernias-study-protocol-for-a-randomised-controlled-trial
#19
J Cornish, R L Harries, D Bosanquet, B Rees, J Ansell, N Frewer, P K Dhruva Rao, C Parry, R Ellis-Owen, S M Phillips, C Morris, J Horwood, M L Davies, M M Davies, R Hargest, Z Davies, J Hilton, D Harris, A Ben-Sassi, R Rajagopal, D Hanratty, S Islam, A Watkins, N Bashir, S Jones, I R Russell, J Torkington
BACKGROUND: Incisional hernias are common complications of midline closure following abdominal surgery and cause significant morbidity, impaired quality of life and increased health care costs. The 'Hughes Repair' combines a standard mass closure with a series of horizontal and two vertical mattress sutures within a single suture. This theoretically distributes the load along the incision length as well as across it. There is evidence to suggest that this technique is as effective as mesh repair for the operative management of incisional hernias; however, no trials have compared the Hughes Repair with standard mass closure for the prevention of incisional hernia formation following a midline incision...
September 15, 2016: Trials
https://www.readbyqxmd.com/read/27557630/strategies-for-assessing-renal-function-prior-to-outpatient-contrast-enhanced-ct-a-uk-survey
#20
Martine Ann Harris, Beverly Snaith, Ruth Clarke
OBJECTIVES: To identify current UK screening practices prior to contrast-enhanced computerised tomography (CT). To determine the patient management strategies to minimise the risk of contrast induced acute kidney injury risk (CI-AKI) in outpatients. METHODS: An invitation to complete an electronic survey was distributed to the CT managers of 174 UK adult NHS hospital trusts. The survey included questions related to local protocols and national guidance on which these are based...
August 25, 2016: British Journal of Radiology
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