Adding MR Diffusion Imaging and T2 Signal Intensity to Neck Imaging Reporting and Data System Categories 2 and 3 in Primary Sites of Postsurgical Oral Cavity Carcinoma Provides Incremental Diagnostic Value

BACKGROUND AND PURPOSE

The NI-RADS lexicon doesn't use ADC parameters and T2 weighted signal for ascribing categories. We explored ADC, DWI, and T2WI to examine the diagnostic accuracy in primary sites of postsurgical oral cavity carcinoma in the Neck Imaging Reporting and Data System (NI-RADS) categories 2 and 3.

MATERIALS AND METHODS

We performed a retrospective analysis in clinically asymptomatic post-surgically treated patients with oral cavity squamous cell carcinoma who underwent contrast-enhanced MRI between January 2013 and January 2016. Histopathology and follow-up imaging were used to ascertain the presence or absence of malignancy in subjects with "new enhancing lesions," which were interpreted according to the NI-RADS lexicon by experienced readers, including NI-RADS 2 and 3 lesions in the primary site. NI-RADS that included T2WI and DWI (referred to as NI-RADS A) and ADC (using the best cutoff from receiver operating characteristic curve analysis, NI-RADS B) was documented in an Excel sheet to up- or downgrade existing classic American College of Radiology NI-RADS and calculate diagnostic accuracy.

RESULTS

Sixty-one malignant and 23 benign lesions included in the study were assigned American College of Radiology NI-RADS 2 (n = 33) and NI-RADS 3 (n = 51) categories. The recurrence rate was 90% (46/51) for NI-RADS three, 45% (15/33) for NI-RADS 2, and 73% (61/84) overall. T2WI signal morphology was intermediate in 45 subjects (53.5%) and restricted DWI in 54 (64.2%). Sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of the American College of Radiology NI-RADS were the following: NI-RADS (75.4%, 78.3%, 90.1%, 54.5%, and 76.1%); NI-RADS A (79.1%, 81.2%, 91.9%, 59.1%, and 79.6%); and NI-RADS B (88.9%, 72.7%, 91.4%, 66.7%, and 85.1%), respectively.

CONCLUSIONS

Adding MR imaging diagnostic characteristics like T2WI, DWI, and ADC to the American College of Radiology NI-RADS improved diagnostic accuracy and sensitivity.

Syphilitic Aneurysm of the Subclavian Artery: Case Report

The authors treated a patient who presented with an aneurysm of the subcla vian-axillary artery, which appeared to be of syphilitic origin. The authors re view the problems of diagnosis and treatment of these aneurysms. The management is surgical and consists in resection and reestablishment of arterial continuity.

Infected hydrocele following laparoscopic appendectomy: case report

In the literature, specific reported complications after laparoscopic appendectomy include bowel injury, hemorrhage, wound infection, and cecal fistula. We report the occurrence of infected hydrocele after laparoscopic appendectomy in a 20-year-old man. This complication, to our knowledge, has not yet been described in the literature.

Should chemical sympathectomy precede below knee amputation?

Lumbar sympathectomy has a controversial place in the management of severe limb ischemia for limb preservation. In a consecutive clinical series laser Doppler (LD) blood flow was measured at the distal limit of an anterior below knee skin flap in 21 patients. Amputation level was selected by clinical judgement. Mean LD value in 15 patients who had primary BK healing was 42V (range 20-85) compared to 11V (9-20) in six patients who proceeded to AK amputation (p < 0.001) establishing 20V as a critical value for BK healing. To examine the effect of chemical sympathectomy 21 further patients with severe ischemia had LD measurements at the same BK site before and one week after chemical sympathectomy. LD values rose significantly from 26V (10-75) to 50V (10-100), (p < 0.001). In particular seven patients had initial LD levels below 20V and in five chemical sympathectomy produced elevation to levels commensurate with BK healing. We conclude that chemical sympathectomy can improve below knee skin blood flow and may enhance primary wound healing.

Sternal fractures: a red flag or a red herring?

We reviewed the records of 28 patients with sternal fractures. Seat belts were used by 79% of the patients. Pain and tenderness were the most common complaints. Forty-six percent of patients had associated injuries, which were all evident in the emergency room. Seven patients had rib fractures, six had myocardial contusion, and five had pulmonary contusions. The associated injuries determined the outcome: 2 patients died, 2 required rehabilitation, the rest recovered uneventfully. Mean length of stay (LOS) was 8.17 +/- 1.78 days, but the median LOS was 4 days, and 75% stayed a week or less. The sternal fracture was treated with rest and analgesics. We conclude that sternal fractures are benign and do not require special treatment or an expensive work-up. It is possible that the seat belt and the sternal fracture absorb a substantial part of the energy transfer, and prevent greater damage.

Spontaneous disappearance of limy bile. A cause of acute pancreatitis?

The spontaneous disappearance of limy bile from the gallbladder causing transient obstructive jaundice and acute pancreatitis is extremely rare. Only five cases causing obstructive jaundice alone have so far been reported. We report a patient with obstructive jaundice and acute pancreatitis in whom the initial abdominal film showed limy bile in the gallbladder, which subsequently disappeared in the following abdominal films.

Adrenal cysts: diagnosis and therapeutic approach

We report nine cases of adrenal cysts, treated in our hospital, between 1980 and 1990. The majority of the cases (5/9) were incidental findings on US and CT examinations. We operated on 4/9 cases because of their symptomatology or their size. Four other cases were managed conservatively; one last case was treated by percutaneous drainage under CT. In our series, 1/9 (11%) was a malignant cyst. The follow-up shows excellent results in the benign cases and 40 months' survival in the malignant case, until today.

Management of periareolar abscess and mamillary fistula

During a 15 year period, 18 patients with 28 mamillary fistulas were treated. In eight women, periareolar abscess had preceded recognition of a fistula. Ten patients were primarily diagnosed as having mamillary fistula. In six patients, when the underlying fistula tract was not identified and excised at the time of operation, discharging sinus reoccurred. Twenty-two fistulas were completely excised together with an extensive lactiferous duct system. Operative wound was primarily closed using antibiotic cover. Periareolar abscess and mamillary fistula should be treated primarily by complete excision of the fistula tract and extensive duct system of the breast.

Isolated popliteal artery occlusion in the young

Three young patients with an isolated popliteal artery occlusion are presented, two with severe claudication and the third with a critical ischaemic foot. The work-up of these patients leads to certain aetiologic possibilities: microtrauma, smoking and contraceptive pills. Two of our patients underwent thromboembolectomy, the third managed conservatively. The follow-up was between six months and seven years and up to now all three patients remain well.

[Abscess of the abdominal wall: a rare presentation of xanthogranulomatous pyelonephritis]

A young psychiatric patient presented with a purulent collection in the lower abdominal wall. Simple drainage failed to heal the abdominal wall abscess, and the presence of a primary septic focus was suspected. Full investigation showed a right renal pelvis calculus with xanthogranulomatous pyelonephritis complicated by a retroperitoneal abscess. Recovery was complete after a nephrectomy. A review of the published literature demonstrated the rarity of this presentation, although even more curious cases have been described, including a urinobronchial fistula, as well as catastrophic cases presenting with a massive haemorrhage. Authors are unanimous that ultrasonography should be the first examination, the scanner being also of primordial value for the diagnosis and demonstration of the retroperitoneal spaces ans fascia. Treatment requires both rapid and radical surgical intervention.

[Is enterolithiasis a disease occurring more frequently in desert climate? Apropos of 8 cases]

This work is a report about 8 cases of enterolithiasis treated in our University Hospital between 1980 and 1990. We emphasize the rarity of this condition. We also note its relative frequency (5 of 8 cases) in the Bedouin population of our mostly desertic area, and question the possible impact of a diet rich in goat's milk and/or of tuberculosis, which is still endemic in some tribes. We then discuss the difficulties of diagnosis and the essential contribution of small bowel radiographs. The etiologies of enterolithiasis are reviewed, as well as the various modalities of treatment.