Raise the bar and lower the dose: current and future strategies for radiation dose reduction in head and neck imaging

SUMMARY

Technologic advances in CT have generated a dramatic increase in the number of CT studies, with a resultant increase in the radiation dose related to CT scanning. Such increase in radiation dose is becoming a concern for the radiology community, especially with increasing public awareness of the dose burden related to examinations. To cope with the increase in CT-related radiation exposure, it is becoming necessary to optimize CT imaging protocols and apply radiation dose reduction techniques to ensure the best imaging with the lowest radiation dose.

Pattern of childhood malignant tumors at a teaching hospital in Kano, Northern Nigeria: A prospective study

Background: Childhood cancers represent an important global public health problem. Survival is still dismal in most low income countries. Materials and Methods: A prospective study of childhood cancers diagnosed at AKTH, Kano was undertaken from January 2003 to December 2009 to determine the pattern, socio-economic and geographical features. Results: Malignant lymphomas constituted 46.5% of all cases, of which 30.1% were Burkitt's lymphoma, 9.8% were Non-Hodgkin (non Burkitt's) lymphoma and 6.6% were Hodgkin lymphoma. Retinoblastoma was the second most common malignancy constituting 15.2% of all cases, followed by Nephroblastoma 12.5% and acute leukemia's accounted for 14.1% of all cases. Others were Neuroblastoma 5.5%, Rhabdomyosarcoma 1.9% and CNS and Hepatissc tumors 4.3%. About 80% of parents of these children are very poor and could not afford the cost of treatment. Fifty one percent of the patients were alive at 12 months and the mortality was 24%. Conclusion: Childhood cancer is common in Kano. Free treatment is what is required since majority of the parents could not afford the cost of treatment.

High-resolution MRI evaluation of neonatal brachial plexus palsy: A promising alternative to traditional CT myelography

BACKGROUND AND PURPOSE

Despite recent improvements in perinatal care, the incidence of neonatal brachial plexus palsy remains relatively common. CT myelography is currently considered to be the optimal imaging technique for evaluating nerve root integrity. Recent improvements in MR imaging techniques have made it an attractive alternative to evaluate nerve root avulsions (preganglionic injuries). We aim to demonstrate utility of MR imaging in the evaluation of normal and avulsed spinal nerve roots.

MATERIALS AND METHODS

All study patients with clinically diagnosed neonatal brachial plexus palsy underwent MR imaging by use of a high-resolution, heavily T2-weighted (driven equilibrium) sequence. MR imaging findings were reviewed for presence of nerve root avulsion from C5-T1 and for presence of pseudomeningocele. The intraoperative findings were reviewed and compared with the preoperative MR imaging findings.

RESULTS

Thirteen patients (9 male, 4 female) underwent MR imaging; 6 patients underwent nerve reconstruction surgery, during which a total of 19 nerve roots were evaluated. Eight avulsions were noted at surgery and in the remainder, the nerve injury was more distal (rupture/postganglionic injury). Six of the 8 nerve root avulsions identified at surgery were at C5-6 level, whereas 1 nerve root avulsion was identified at C7 and C8 levels, respectively. The overall sensitivity and specificity of MR imaging for nerve root avulsions was 75% and 82%, respectively.

CONCLUSIONS

Our preliminary results demonstrate that high-resolution MR imaging offers an excellent alternative to CT myelography for the evaluation of neonatal brachial plexus palsy with similar sensitivity compared with CT myelography.

Pediatric HIV in Kano, Nigeria

BACKGROUND

Pediatric human immunodeficiency virus (HIV) infection is still an important public health issue despite a decrease in global, national, and local seroprevalence rates.

DESIGN

A prospective, hospital-based study was conducted.

MATERIALS AND METHODS

One-hundred and sixty children presenting for the first time to the hospital were studied. Each child had a detailed physical examination and initial double rapid HIV antibody tests. A virological confirmatory test was done for those aged less than 18 months of age with positive results. Mothers of HIV-infected children also had HIV testing. HIV-infected children were enrolled into HIV care and followed up for 6 months. Data were analyzed using the SPSS 16.0 for Windows.

RESULTS

Twenty-two (13.8%) children were confirmed HIV-infected. The mean age was 26.9 ± 30.8 months. Male to female ratio was 1.1:1. Probable modes of transmission were mother-to-child in 63.6%, group circumcision in 22.7%, sexual transmission in 9.1% and unscreened blood transfusion in 4.5%. The most frequent symptoms on presentation were fever in 95.4% of patients, cough and weight loss in 77.3% and diarrhoea in 59.1%. The most common signs were hepatomegaly in 77.3%, pyrexia and crepitations in 72.7%, and pallor in 40.9%. Commonly diagnosed conditions were undernutrition, diarrheal disease, oral thrush, and pneumonia. Tuberculosis co-infection was diagnosed in 18.2% of children. Fourteen (63.6%) children had advanced and severe immunodeficiency. Mortality rate over 6 months was 18.2%.

CONCLUSION

Early diagnosis of pediatric HIV and prompt institution of treatment in children would go a long way in reducing the scourge of the disease.

Swallowable Obalon® gastric balloons as an aid for weight loss: a pilot feasibility study

The goal of this study was to evaluate the safety and the impact on weight loss of a new swallowable gastric balloon. In this prospective pilot study, 17 overweight or obese patients were included. Up to three balloons were ingested under fluoroscopic control. All balloons were removed by upper GI endoscopy, 12 weeks after the ingestion of the first balloon. 43 out of 44 attempts (98 %) to swallow a balloon were successful. Nausea and stomach pain were the most frequent side effects. Endoscopic procedures for balloon removal were uneventful. Weight loss was significant at weeks 4, 8, and 12. This pilot study showed no significant side effects induced by up to three balloons, and a significant weight loss.

Endoscopic treatment of acute variceal hemorrhage by using hemostatic powder TC-325: a prospective pilot study

BACKGROUND

Current standard of care of acute variceal bleeding (AVB) combines hemodynamic stabilization, antibiotic prophylaxis, pharmacological agents, and endoscopic treatment. The latter may be challenging in an emergency setting with active bleeding that interferes with visualization.

OBJECTIVE

To assess the effectiveness of a pre-established delivery protocol of a hemostatic powder to control AVB originating from the esophagus or the gastroesophageal junction.

DESIGN

Prospective, 2-center study.

SETTING

Two tertiary-care referral university hospitals.

PATIENTS

Nine patients who received endoscopic hemostatic powder for actively bleeding varices.

INTERVENTIONS

Endoscopic hemostasis.

MAIN OUTCOME MEASUREMENT

Primary hemostasis and rebleeding rates.

RESULTS

Nine consecutive patients with confirmed AVB underwent treatment within 12 hours of hospital admission. Bleeding stopped during the endoscopy performed with application of 21 g of hemostatic powder from the cardia up to 15 cm above the gastroesophageal junction. No rebleeding was observed in any of the patients within 24 hours. No mortality was observed at 15-day follow-up.

LIMITATIONS

Small sample size.

CONCLUSION

Hemostatic powder has the potential to temporarily stop AVB. (

CLINICAL TRIAL REGISTRATION NUMBER

NCT01783899.)

Efficacy of a static progressive stretch device as an adjunct to physical therapy in treating adhesive capsulitis of the shoulder: a prospective, randomised study

BACKGROUND

Stress relaxation and static progressive stretch are techniques used for non-surgical restoration of shoulder range of motion for patients with adhesive capsulitis.

OBJECTIVES

To compare a static progressive stretch device plus traditional therapy with traditional therapy alone for the treatment of adhesive capsulitis of the shoulder.

DESIGN

Prospective, randomised controlled trial.

PARTICIPANTS

Sixty patients with adhesive capsulitis of the shoulder were assigned at random to an experimental group or a control group.

INTERVENTIONS

Both groups received three traditional therapy sessions per week for 4 weeks. In addition, the experimental group used a static progressive stretch device for 4 weeks.

MAIN OUTCOME MEASURES

The primary outcome measure was shoulder range of motion (active and passive shoulder abduction, and passive shoulder external rotation). The secondary outcome measures were function [measured by the Disabilities of the Arm, Shoulder and Hand (DASH) questionnaire] and pain [measured using a visual analogue scale (VAS)].

RESULTS

At baseline, there were no differences between the two groups. However, after the intervention, there were significant (P<0.05) differences between the groups for all outcome parameters: 0.3 for mean VAS scores [95% confidence interval (CI) -0.6 to 1.1], -10.1 for DASH scores (95% CI -21.0 to 0.9), 21.2° for shoulder passive external rotation (95% CI 16.8 to 25.7), 26.4° for shoulder passive abduction (95% CI 17.4 to 35.3), and 27.7° for shoulder active abduction (95% CI 20.3 to 35.0). At 12-month follow-up, the differences between the groups were maintained and even increased for mean shoulder range of motion, VAS scores and DASH scores, with significant differences (P<0.001) between the groups: -2.0 for VAS scores (95% CI -2.9 to -1.2), -53.8 for DASH scores (95% CI -64.7 to -42.9), 47.9° for shoulder passive external rotation (95% CI 43.5 to 52.3), 44.9° for shoulder passive abduction (95% CI 36.0 to 53.8), and 94.3° for shoulder active abduction (95% CI 87.0 to 101.7).

CONCLUSION

Use of a static progressive stretch device in combination with traditional therapy appears to have beneficial long-term effects on shoulder range of motion, pain and functional outcomes in patients with adhesive capsulitis of the shoulder. At 12-month follow-up, the experimental group had continued to improve, while the control group had relapsed.

On the spectroscopic analyses of thioindigo dye

A combined experimental and theoretical study on molecular structure and vibrational frequencies of thioindigo was reported. The FT-IR spectrum of thioindigo is recorded in the solid phase. The equilibrium geometries, harmonic vibrational frequencies, thermo-chemical parameters, total dipole moment and HOMO-LUMO energies are calculated by density functional theory DFT/B3LYP utilizing 6-311G(d,p) basis set. Results showed that cis-isomer is highly recommended to be a promising structure for many applications in optoelectronic devices due to its high calculated dipole moment value (3.44 Debye) which indicates its high reactivity to interact with the surrounding molecules as compared to the trans-isomer which has no dipole moment. Both isomers have a similar HOMO-LUMO energy gap, of 3.02 eV (cis-isomer) and 2.78 eV (trans-isomer).

FT-IR spectroscopic analyses of 3-Methyl-5-Pyrazolone (MP)

In the present work both experimental and computational FT-IR spectroscopic studies on 3-Methyl-5-Pyrazolone (MP) were reported. Experimental FT-IR spectrum for MP compound is recorded in powder form. Important physical parameters were reported such as structural parameters, vibrational frequencies, entropy, total energy, total dipole moment and HOMO-LUMO energy gap using DFT/B3LYP/6-311G(d,p) basis set. MP molecule has a total dipole moment of 2.83 Debye and HOMO-LUMO energy gap of 5.80 eV. Results indicate also that exposure to UV changes the spin from singlet to doublet state; one can conclude that MP compound may undergo anomalous Zeeman like effect.

Evaluation of adenosine deaminase activity for diagnosis of tuberculous pleural effusion

Background: Tuberculosis is a leading cause of worldwide preventable morbidity and mortality from an infectious agent. A defi nite diagnosis of tubercular pleural effusion can be diffi cult to make because of low sensitivity and/or specifi city of noninvasive traditional diagnostic tools. This study is done to fi nd out a sensitive and specifi c marker for early diagnosis of tuberculous pleural effusion. Materials and Methods: One hundred and three pleural effusion cases were enrolled in the study, out of which 62 were tuberculous pleural effusion cases and 49 were non-tuberculous cases. Results: Considering 40 U/L as a cut off value for Adenosine deaminase assay level, the test result was positive in 58 out of 62 patients of tuberculosis indicating sensitivity of the test as 94%; however, among 41 non-tuberculous patients, 5 presented ADA activity level more than 40U/L, which lowers the specifi city of the test to 88%. ADA levels were signifi cantly higher in tuberculous than in non tuberculous cases (P value <0.001). Conclusion: It may be concluded that ADA levels are signifi cantly high in patients with tuberculous pleural effusion compared to that in non tuberculous group. Sensitivity (94%) and specifi city (88%) of the test in tuberculous pleural effusions are very high, when cut off value set at 40U/L. The result indicated that the analysis of ADA levels in pleural effusion constitute a very useful marker for the diagnosis of TPE which, in addition, can be made quickly in a non- invasive way. Journal of Pathology of Nepal (2013) Vol. 3, No.1, Issue 5, 367-373 DOI: http://dx.doi.org/10.3126/jpn.v3i5.7860

Evaluation of protective effect of Sapindus mukorossi saponin fraction on CCl(4)-induced acute hepatotoxicity in rats

Aim

This investigation aimed to assess the hepatoprotective effect of saponin fraction isolated from the fruit pericarp of Sapindus mukorossi on carbon tetrachloride (CCl₄)-induced hepatotoxicity.

Methods

Fruit of S. mukorossi was collected and authenticated, and dried pericarp powder subjected to extraction with cold ethanol (70%) by maceration followed by isolation of total saponin fraction. Hepatoprotective activity was demonstrated in the CCl₄-damaged primary monolayer culture. In in vivo studies, pretreatment with total saponin fraction (50,100 and 150 mg/kg per os once a day for 4 days before CCl₄ introduction and continued afterward for 3 days) attenuated the CCl₄-induced acute increase in serum glutamic pyruvic transaminase, serum glutamic oxaloacetic transaminase, and alkaline phosphatase activities and considerably reduced histopathological alterations. Further, saponin fraction reduced thiopentone-induced (4 mg/kg, intraperitoneal) sleeping time in rats.

Results

Saponin fraction pretreatment improves bromsulphalein clearance and also increases cellular viability. Saponin administration replenished depleted hepatic glutathione and superoxide dismutase by improving the antioxidant status of the liver and liver function enzymes. These effects substantiate protection of cellular phospholipids from peroxidative damage induced by highly reactive toxic intermediate radicals formed during biotransformation of CCl₄.

Conclusion

The above findings lead to the conclusion that the saponin fraction of S. mukorossi has a protective capability both in vitro on primary hepatocyte cultures and in vivo in a rat model of CCl₄-mediated liver injury. Hence, we suggest that the inclusion of this S. mukorossi fruit pericarp in the management of liver disorders is justified.

Pneumonectomy: quality of life and long-term results

AIM

Pneumonectomy is the standard surgery for resectable locally advanced lung cancer. Objectives of this study were: 1) to assess the overall survival; 2) to evaluate the pulmonary and cardiac function impairment; 3) to monitor quality of life (QoL) in a consecutive series of patients undergoing pneumonectomy, defining the potential risk factors of a poor prognosis.

METHODS

From January 2003 to March 2010, 71 patients undergoing pneumonectomy for lung cancer or mesothelioma were prospectively enrolled in this study. Twenty-six patients underwent right pneumonectomy (2 of them underwent intrapericardial pneumonectomy), 31 left pneumonectomy (3 of them underwent intrapericardial pneumonectomy), 3 extended pneumonectomy, 3 extrapleural pneumonectomy and 5 patients underwent completion pneumonectomy. Three patients were not included in the study for early postoperative deaths (4.3%). All patients underwent complete preoperative assessment and one year after surgery. QoL was assessed by a questionnaire.

RESULTS

One and five-year survival rate was 93% (N.=63) and 20% (N.=14), respectively. Mean values of FEV1 decreased from 2.59±0.75 L to 1.8±0.72 L (P<0.001). One year after surgery all patients showed moderate tricuspid valve insufficiency, PASP significantly higher and right ventricular free wall thickness moderately increased. An increased negative effect was recorded in the QoL scores with P<0.001. Three clinical and surgical parameters were identified as risk or protective factors for the survival outcome.

CONCLUSION

Postoperative mortality (4.3%) and five-year survival (20%) after pneumonectomy seem to be satisfactory. Late cardiopulmonary insufficiency is uncommon and acceptable QoL is still achievable.

On the spectroscopic analyses of (E)-3-(dicyclopropyl methylene)-dihydro-4-[1-(2,5 dimethylfuran-3-yl) ethylidene]furan-2,5-dione

In this work, a combined experimental and theoretical study on molecular structure and vibrational frequencies of (E)-3-(dicyclopropyl methylene)-dihydro-4-[1-(2,5 dimethylfuran-3-yl) ethylidene] furan-2,5-dione [DCPF] were reported. The FT-IR spectra of DCPF isomers are recorded in the solid phase. The equilibrium geometries, harmonic vibrational frequencies, thermo-chemical parameters, total dipole moment and HOMO-LUMO energies are calculated by density functional theory DFT/B3LYP utilizing 6-311G(d,p) basis set. Results showed that scaled frequencies are in good agreement with experimental values. The HOMOs and the LUMOs energies of DCPF isomers were 3.8 and 2.7eV for E and C isomers,respectively.

17-(Pyrimidin-2-yl)-8,16-dioxa-17-aza-tetra-cyclo-[7.7.1.0.0]hepta-deca-2,4,6,10,12,14-hexa-ene

In the title compound, C(18)H(13)N(3)O(2), the benzene rings form a dihedral angle of 78.49 (9)°. The dihedral angles between the benzene rings and the pyrimidine ring are 76.53 (10) and 27.73 (11)°. The two cis-fused six-membered heterocyclic rings adopt half-chair confirmations. In the crystal, mol-ecules are linked by C-H⋯O hydrogen bonds, forming chains parallel to the b axis.

The influence of geometrical tolerances of Vickers indenter on the accuracy of measured hardness

This paper reports work carried out to determine the influence of the Pyramidal indenter geometrical errors and tolerances on the accuracy of Vickers hardness measurements. The angle between the opposite faces and line of conjunction of nine indenters were measured by the optical comparator. The influence of the indenter geometry on the hardness accuracy is investigated. Three calibrated reference hardness test blocks were used to check the Vickers hardness test using the nine selected indenters. The results show that the geometrical error of the indenters (specially the angles) considerably affects the accuracy of the hardness measurement. Finite element analysis of the indentation process into metallic test pieces was conducted. Comparison of the experimental results with the numerical findings was discussed. Errors in the experimental values are correlated with measured tolerances in the angles between faces.

Evaluation of Fujinon intelligent chromo endoscopy-assisted capsule endoscopy in patients with obscure gastroenterology bleeding

AIM: To investigate the potential benefit of Fujinon intelligent chromo endoscopy (FICE)-assisted small bowel capsule endoscopy (SBCE) for detection and characterization of small bowel lesions in patients with obscure gastroenterology bleeding (OGIB).

METHODS: The SBCE examinations (Pillcam SB2, Given Imaging Ltd) were retrospectively analyzed by two GI fellows (observers) with and without FICE enhancement. Randomization was such that a fellow did not assess the same examination with and without FICE enhancement. The senior consultant described findings as P0, P1 and P2 lesions (non-pathological, intermediate bleed potential, high bleed potential), which were considered as reference findings. Main outcome measurements: Inter-observer correlation was calculated using kappa statistics. Sensitivity and specificity for P2 lesions was calculated for FICE and white light SBCE.

RESULTS: In 60 patients, the intra-class kappa correlations between the observers and reference findings were 0.88 and 0.92 (P2), 0.61 and 0.79 (P1), for SBCE using FICE and white light, respectively. Overall 157 lesions were diagnosed using FICE as compared to 114 with white light SBCE (P = 0.15). For P2 lesions, the sensitivity was 94% vs 97% and specificity was 95% vs 96% for FICE and white light, respectively. Five (P2 lesions) out of 55 arterio-venous malformations could be better characterized by FICE as compared to white light SBCE. Significantly more P0 lesions were diagnosed when FICE was used as compared to white light (39 vs 8, P < 0.001).

CONCLUSION: FICE was not better than white light for diagnosing and characterizing significant lesions on SBCE for OGIB. FICE detected significantly more non-pathological lesions. Nevertheless, some vascular lesions could be more accurately characterized with FICE as compared to white light SBCE.