Improving the radiological diagnosis of hepatic artery thrombosis after liver transplantation: Current approaches and future challenges

Hepatic artery thrombosis (HAT) is a devastating vascular complication following liver transplantation, requiring prompt diagnosis and rapid revascularization treatment to prevent graft loss. At present, imaging modalities such as ultrasound, computed tomography, and magnetic resonance play crucial roles in diagnosing HAT. Although imaging techniques have improved sensitivity and specificity for HAT diagnosis, they have limitations that hinder the timely diagnosis of this complication. In this sense, the emergence of artificial intelligence (AI) presents a transformative opportunity to address these diagnostic limitations. The develo pment of machine learning algorithms and deep neural networks has demon strated the potential to enhance the precision diagnosis of liver transplant com plications, enabling quicker and more accurate detection of HAT. This article examines the current landscape of imaging diagnostic techniques for HAT and explores the emerging role of AI in addressing future challenges in the diagnosis of HAT after liver transplant.

Interpeduncular angle: A new parameter for assessing intracranial hypotension in fetuses with spinal dysraphism

OBJECTIVE

To investigate the role of the interpeduncular angle (IPA) as a new indicator of intracranial hypotension in fetuses with open spinal dysraphism (SD).

METHODS

Two groups of fetuses undergoing magnetic resonance imaging (MRI) examination were identified. The study group included fetuses with open SD (n = 21), while the control group included fetuses with a normal brain and spine (n = 43). Two observers retrospectively evaluated axial T2-weighted images of the brain and the IPA was identified and measured. Other features of the Chiari II malformation were also evaluated in the study group and correlated with the IPA.

RESULTS

The average value (±SD) of the IPA for the study and control groups was 9.8° ± 18.5° and 60.2° ± 5.9°, respectively. The intergroup analysis of the IPA measurements revealed a statistically significant difference between the groups (p < 0.005). Brainstem slumping or cerebellar tonsillar descent, collapse of the fourth ventricle, and ventriculomegaly also had a significant correlation with a lower IPA (p = 0.001).

CONCLUSION

Measuring the IPA may be a useful technique for assessing the degree of intracranial hypotension in fetuses with open SD. This technique can also detect less severe cases of prenatal intracranial hypotension, even before cerebellar tonsillar descent. The lower IPA in fetuses with open SD further supports the theory that cerebrospinal fluid leakage, and not traction, is the underlying cause of Chiari II malformation.

Increasing public involvement in enriching our fish stocks through genetic enhancement

A total of 70%, of the world's conventional commercial fish species are now fully exploited, overexploited, depleted or recovering from depletion. This dramatic crash in the capture world fisheries production has led to problems in foods distribution, balance of payments, employment, and ecological depletion. Public support for breeding programs with terrestrial farm animals and plants in agriculture have revolutionized this industry over the past few hundred years. However, new genetic rearing technologies to improve marine animal production through aquaculture that utilize modern biology to obtain sustainable aquaculture and preserve biodiversity provide a promise to address these problems. However aquaculture has not been subject to public discussion and approval. Public involvement, not necessarily acquiescence, provide value added in the decision making process. Public understanding and involvement involves three stages. (i) Public concern over the pool of genetic information; (ii) if aquaculture is to respond to the fisheries crises with innovation, the knowledge gap between public understanding and scientific information must be bridged; and (iii) strategies must be developed for achieving this. Release of recombinant DNA to the environment, and handling exotic species, are useful case studies. Illustrations will be given of communication bridges to the public and ways to involve the public in making policy decisions.

[Clinical and laboratory characteristics of patients with pathologic chronic gastroesophageal reflux]

BACKGROUND

Sixty percent of adults has typical symptoms of gastroesophageal reflux in Chile.

AIM

To report the clinical and laboratory features of patients with gastroesophageal reflux.

PATIENTS AND METHODS

Five hundred thirty-four patients (255 male) with gastroesophageal reflux were included in a prospective protocol that included clinical analysis, manometry and endoscopy in all patients, barium swallow in 427, scintigraphy in 195, acid reflux test in 359, 24 h pH in 175, and differential potential of gastroesophageal mucosa in 73 patients.

RESULTS

There was no correlation between the severity of symptoms and the endoscopical severity. Patients with Barret esophagus were 12 years older, were male in a greater proportion and had a higher proportion of manometrically incompetent sphincters than patients with esophageal reflux but without esophagitis or with erosive esophagitis. Severity of acid reflux, measured with 24 h pH monitoring was proportional to the endoscopical damage of the mucosa. There was a close relationship between the mucosal change limit determined with differential potentials and with endoscopy. No short esophagi were found.

CONCLUSIONS

Patients with symptoms of gastroesophageal reflux must be assessed using several objective measures to determine the severity of their pathological alterations.

'Carditis': an objective histological marker for pathologic gastroesophageal reflux disease

In a prospective endoscopic and bioptic study, 141 control subjects and 359 patients with symptoms of gastroesophageal reflux (GER) were included to determine the prevalence of cardial epithelium inflammation or 'carditis' and to determine the prevalence of Helicobacter pylori in this area. Two biopsies at the antrum, four distal to the squamous-columnar junction and two proximal in the esophageal mucosa, were taken. Patients with gastroesophageal reflux were divided into four groups, according to the severity of endoscopic findings: patients without esophagitis, patients with erosive esophagitis, patients with short-segment and long-segment Barrett's esophagus (BE). Control subjects had normal histological findings at the cardia in 90% of cases, fundic mucosa being present twice as cardial epithelium. Carditis was present in 8% of cases and intestinal metaplasia (IM) in 2%. On the contrary, patients with GER had carditis in nearly 50% of cases. Intestinal metaplasia was present in 12% of cases with GER without esophagitis or erosive esophagitis, in 35% of cases with short-segment BE and in 65% of the cases with long-segment BE. IM at the antrum was present in only 5% of cases. Helicobacter pylori at the squamous-columnar junction was present in 13% of control subjects and in 30% of the patients with GER. It is concluded that carditis is an easy and objective marker for the presence of chronic gastroesophageal reflux and the presence of Helicobacter pylori at this region must be carefully evaluated in order to determine some pathogenic role for the development of Barrett's esophagus.

[Testicular adrenal rests tumor: a difficult diagnosis]

This paper presents the case of a 19 year old patient with a well defined under palpation testicular tumor where surgical examination allowed a simple enucleation. Histological analysis during the operation reported it as a Leydig cells tumor but definitive analysis indicated tumor by adrenal residues. This histological argument illustrates the difficulty of making a differential diagnosis between both tumors, difficulty that goes beyond morphological and even clinical appreciation.

[Bladder endometriosis]

Although uncommon, vesical endometriosis is considered an important disease entity due to the diagnostic difficulties it presents and the different therapeutic options that are available. A case of long-standing vesical endometriosis that caused considerable suffering to the patient is reported. The foregoing condition was refractory to hormone therapy and late radical surgical treatment by partial cystectomy and hysterectomy failed to achieve good results. The clinical and therapeutic aspects of the present case are compared with those reported elsewhere. We underscore the importance of biopsy by transurethral resection in its diagnosis as well as the need for a more effective therapeutic approach.

[Psoas abscess: considerations on 6 cases]

We present six cases of psoas abscess, three primary and three secondary. The etiologic, pathogenic and therapeutic considerations are outlined. Staphylococcal infections prevail in the primary abscesses. The diagnostic difficulties are considerable but nowadays are facilitated by echography and TAC. In the secondary ones, the psoas abscess is an epiphenomenon of a more easily recognised clinical syndrome. It is surprising how these septic processes are increasingly placed in the hands of urologists in recognition of their mastery of retroperitoneal surgery.

[Spontaneous rupture of the ureter caused by an impacted stone]

We report a case of spontaneous rupture of the ureter from an impacted calculus, paradigm of diagnostic and therapeutic difficulties of these uncommon pathologic conditions. Spontaneous rupture of the ureter from an impacted calculus should be considered in cases of persistent renal colic and atypical presentation. Diagnosis is based on urographic evidence of urinary extravasation. This should be differentiated from nephric colic from urinary extravasation arising from the renal fornices which is relatively common in nephric colic. Treatment must always include drainage of the urinoma, ureteroraphy, and urinary diversion. However, a controversy exists on the advantages and disadvantages of nephrostomy versus ureteral splinting.