Frodita Jakimovska, Marina Davceva Cakar and Dejan Dokic
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Zsolt Parajkó, András Mester, István Kovács, Lehel Bordi, Ioana Cîrneală, Diana Opincariu, Nóra Raț, Monica Chițu and Imre Benedek
Coronary computed tomography angiography (CCTA) is a reliable screening method of patients with coronary artery disease (CAD). CCTA is capable to assess both coronary stenosis and plaque morphology, but does not provide hemodynamic characterization of the coronary lesions. However, the severity of coronary stenosis does not always reflect the hemodynamic significance of the plaque. Invasive fractional flow reserve (FFR) is considered the gold standard for the functional evaluation of a potential ischemia-causing stenosis. FFR derived from CCTA (FFR-CT) is a new noninvasive diagnostic tool, using a typically acquired CCTA, without the need for any further radiation or medication. Additional functional assessment of the coronary lesions permits a more complex characterization of CAD patients. Based on the FFR-CT examination, patients who need invasive coronary intervention can be selected more precisely, and a more personalized and optimized treatment can be provided.
Yingke He, John Ong, Thuan Tong Tan, Brian K. P. Goh and Sharon G. K. Ong
biomarkers such as CRP, Interleukin 6 and 8, soluble TREM 1 and PLAUR[ 18 , 19 , 20 ].
A recent systematic review and meta-analysis by Tan et al. (2019) looking at the diagnostic accuracy of both PCT and CRP concluded that PCT was a better diagnostic tool for sepsis [ 21 ]. Their data gave an AUROC score CRP: 0.73 (95% CI 0.69 - 0.77) vs AUROC score PCT: 0.85 (95% CI 0.82 - 0.88). However, both biomarkers were found to have moderate specificity with wide confidence intervals. Interestingly, recent advancements in biotechnology have facilitated DNA-based molecular
It is a power point program, which through a succession of steps, allows the obtaining of one shorter diagnosis, from a long list of possible ones, by choosing a character of the bone lesion. The aim of this program is to facilitate the differential diagnosis of this particular aspect of a bone lesion - the cystic, expansile osteolytic bone lesion - from a radiological point of view, but not only. The location, age, pain and other condition will be considered and will represent the first criteria in the differentiation. In this differential diagnosis, we discovered not only benign tumor lesions but also malign bone lesions or other non-tumoral conditions. We considered that this program could be easily used by the radiologist or the orthopedist in training and useful by also employing a representative photo gallery.
E. Liciu, B. Frumuşeanu, B.M. Popescu, D.C. Florea, L. Niculescu and A. Ulici
Introduction. Among the cases of malignant tumors, gathering 30% of them, the most frequent is the osteosarcoma. It occurs especially in children and young adults, the mean age being 14 years old. The treatment consists initially in neoadjuvant chemotherapy, followed by the surgical removal of the tumor. Due to aggressive malignant features (rapid increase in size, tendency to invade surrounding tissues, variable location), in multiple cases, the surgical treatment of osteosarcoma becomes a true challenge. Materials and methods. Nowadays, it is possible to create 3D printed models, by using CT and MRI, which are superior to the 3D graphical reconstructions. The 3D printing technique facilitates the production of these 1:1 scale printed models that faithfully embody the patient’s particular features concerning the anatomic pathology. The benefits gained from using such a modern tool allow the orthopedic surgeons to establish the measurements of a precise resection and to simulate the surgical maneuvers, as part of an elaborated modern surgical planning. Results. In this article, we presented the case of a 10-year-old patient diagnosed with femoral osteosarcoma and treated with neoadjuvant chemotherapy followed by GMRS surgical approach based on a preoperative planning involving a 3D printed model. This piece was used to provide precise information regarding the tumor, to allow preoperative measurements and a surgical simulation. Conclusion. The surgical accuracy can be increased by using a personalized preoperative planning based on a 3D printed model, leading to a lower rate of long/ short-term complications, recurrences, or metastases.
Bogdan Ştefan Creţu, Călin Dragosloveanu, Dragoş Cotor, Şerban Dragosloveanu and Cristian Ioan Stoica
Pathological fractures occur in an area of bone where either the quantity or quality of bone is modified and the main cause of bone metastases that weaken the structure and will lead to fractures are in high proportion given by visceral tumors or primary hematopoietic tumors like myeloma.
This paper’s objective was to review the actual knowledge in the treatment of fractures secondary to metastases. Spinal lesions were not discussed in this paper.
Literature search was performed using MEDLINE and Web of Science to find literature relevant to fracture risk and prophylactic intervention in metastatic bone disease. The Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guideline was used for this review. As results, we identified 30 papers that were suitable for this review. Most of them concluded that it is difficult to assess the amount of bone involvement on radiographs alone. Using the actual guidelines for prophylactic fixation may result in an under treatment or overtreatment of patients with metastatic bone disease. Their ability to determine which metastatic bone lesions will fracture is altered mainly because of the small number of patients included in the studies. The prediction factors for fracture risk are still to be evaluated. CT, FDG-PET or CT scan-based finite element analysis may be useful tools for the identification of impending pathological fractures requiring prophylactic stabilization.
Tiberiu Ezri, Ronen Waintrob, Yuri Avelansky, Alexander Izakson, Katia Dayan and Mordechai Shimonov
Background: The incidence of difficult intubation (DI) in obese patients may reach a two-digit figure. No studies have assessed the effect of primary use of special intubation devices on lowering the incidence of DI. We assessed the effect of primary selection of special intubation techniques on the incidence of DI in patients with a BMI of 35 kg/m2 or higher. Patients and methods: Data from 546 patients with a BMI of 35 kg/m2 or higher who underwent bariatric surgery at Wolfson Medical Center from 2010 through 2014 was retrospectively extracted and analyzed for demographics, predictors of DI and intubation techniques employed. Difficult intubation was defined as the presence of at least one of the followings: laryngoscopy grade 3 or 4, need for >1 laryngoscopy or intubation attempt, need for changing the blade size, failed direct laryngoscopy (DL), difficult or failed videolaryngoscopy (VL-Glidescope), difficult or failed awake fiberoptic intubation (AFOI) and using VL or awake AFOI as rescue airway techniques. Primary intubation techniques were direct DL, VL and AFOI. We correlated the predictors of DI with the actual incidence of DI and with the choice of intubation technique employed. Results: The overall incidence of DI was 1.6% (1.5% with DL vs. 2.2 with VL + AFOI, p = 0.61). With logistic regression analysis, age was the only significant predictor of DI. Predictors of DI that affected the selection of VL or AFOI as primary intubation tools were Mallampati class 3 or 4, limited neck movement, age, male gender, body mass index and obstructive sleep apnea syndrome. Conclusion: The lower incidence of DI in our study group may stem from the primary use of special intubation devices, based on the presence of predictors of DI.
Introduction. It is known that bone tumors have a predilection to develop for a certain skeletal bone segment. Also, bone tumors have a predilection for certain age groups. The knee is a common site for bone tumors. Purpose. Presentation of diagnostic parameters of conventional radiography as the first technique in the detection and characterization of bone tumors developed at the knee level and the criteria for differentiation of the malignant substrate from the benign (the type of bone destruction, the type of periosteal response, poorly defined margins) one. The value of MRI is also presented and illustrated as a unique imaging technique that allows the direct visualization of bone marrow with high spatial resolution for local staging of bone tumors. Material and method. The present study aimed to investigate the radiographic and MRI imaging characteristics of bone tumors developed at the knee joint, which were retrospectively analyzed (October 2007 and November 2017) in a selected group of 91 patients. The limit of age between 11 and 67 years, 73(70%) men, 18 (30%) women. Examination protocol: complete clinical examination, radiographic knee examination in anteroposterior and lateral incidents. MRI standard protocol, native, and post paramagnetic contrast. Results. Conventional Radiographic and MRI have been detected and characterized a number of 55 (67%) primary malignant bone tumors confirmed by histopathological diagnosis, ranging from 8 histopathological types and 37 (33%) cases of benign tumors with 9 histopathological types. Conclusions. Radiological examination is the first investigation in the evaluation of knee bone tumors, suggesting the malignant nature expressed by the badly defined margin, bone destruction, discontinuous peristaltic reaction, and extension to the soft parts. MRI is a unique imaging technique that allows direct visualization of bone marrow with high spatial resolution and best tool for local staging of bone tumors.
Mihaela Patriciu, Andreea Avasiloaiei, Mihaela Moscalu and Maria Stamatin
Introduction: Although screening for congenital heart defects (CHD) relies mainly on antenatal ultrasonography and clinical examination after birth, life-threatening cardiac malformations are often not diagnosed before the patient is discharged.
Aim: To assess the use of routine pulse oximetry in the delivery room and at 24 hours postpartum, and to study its feasibility as a screening test for CHD.
Material and Methods: In this prospective study, all infants born in “Cuza Voda” Maternity Hospital, Iasi, Romania, were enrolled over a thirteen-month period. Preductal oximetry was assessed during the first hour, and postductal oximetry was evaluated at twenty-four hours postpartum. Data were then analyzed to establish the sensitivity and specificity of pulse oximetry, as a screening test for CHD.
Results: 5406 infants were included in the study, with a mean gestational age of 38.2 weeks and a mean birth weight of 3175 grams. During the first minute, blood oxygen saturation varied between 40% and 90% and at 24 hours of life, it ranged between 90% and 100%. Following oximetry assessment, 14 infants with critical CHD were identified. Blood oxygen saturation values in infants with CHD were lower throughout the entire period of evaluation. Pulse oximetry had good sensitivity and specificity at 1 hour (Se=87.5%, Sp=95.5%) and 24 hours (Se=92.5%, Sp=97.4%) for the diagnosis of CHD. Blood oxygen saturation values at one minute, 1 hour and 24 hours are strong discriminative parameters for the early diagnosis of CHD.
Conclusion: Routine pulse oximetry during the first 24 hours postpartum represents an early indicator of CHD to facilitate timely intervention. Pulse oximetry provides excellent sensitivity and specificity and has tremendous potential as a standard screening test for CHD during the first 24 hours of life.