Bronchus sign on CT in peripheral carcinoma of the lung: value in predicting results of transbronchial biopsy

The bronchus sign on CT represents the presence of a bronchus leading directly to a peripheral pulmonary lesion. We investigated the value of this sign in predicting the results of transbronchial biopsy and brushing in 33 consecutive cases of proved peripheral bronchogenic carcinoma studied with thin-slice CT (2-mm-thick sections). The bronchus sign was seen on CT in 22 patients and was absent in 11. Transbronchial biopsy and brushing showed peripheral carcinoma in 13 (59%) of 22 patients in whom the bronchus sign was seen on CT and in only two (18%) of 11 patients in whom it was not seen. The difference is statistically significant (Fisher's exact test, p = .029). When analyzed by the order of involved bronchus, a 90% success rate of transbronchial biopsy and brushing was found in patients in whom the bronchus sign was seen at a fourth-order bronchus (p = .01). This compared with a success of 33% when the bronchus sign was seen at fifth-, sixth-, or seventh-order branches. Our results suggest that the bronchus sign at a fourth-order bronchus is valuable in predicting the success of transbronchial biopsy and brushing. The presence of the sign on CT may be useful in determining if the workup should include transbronchial biopsy and brushing or transthoracic needle aspiration in patients with peripheral lung lesions.

Contrast-enhanced MR imaging with fat suppression in adult-onset septic spondylodiscitis

Spinal infections typically involve vertebrae as well as discs, and for this reason they are called septic spondylodiscitis. Magnetic resonance imaging is the most sensitive imaging method for the evaluation of this group of spinal diseases. The use of contrast-enhanced T1-weighted sequences with fat suppression, if correctly applied, may increase information provided by MRI. Firstly, this technique allows the primary vertebral focus, which often precedes disc involvement, to be identified at a very early stage. When the disease spreads, T1-weighted fat-suppressed gadolinium dimeglumine (Gd-DTPA) enhanced images provide macroscopic details of the primary vertebral focus, disc involvement patterns, and pathways of infection diffusion. All this information, when correlated with laboratory tests, may be useful in identifying the infectious agents (tuberculous vs piogenic forms), thus enabling a suitable therapy to be started. This technique is also useful in the assessment of the real extension of the disease, providing a clear depiction of paravertebral space involvement and of psoas muscle abscesses. Dangerous complications, such as meningitis, myelitis, and epidural abscesses, may be more promptly diagnosed and fully evaluated with fat-suppressed post-contrast T1-weighted images. Finally, this imaging technique may help to differentiate infectious processes from degenerative disorders, extradural neoplastic processes, and rheumatic diseases.

Tourette syndrome (TS) bears a higher rate of inflammatory complications at the implanted hardware in deep brain stimulation (DBS)

BACKGROUND

Deep brain stimulation (DBS) is a commonly performed surgical technique for the treatment of movement disorders, and recent surgical trials concerning the treatment of a wider range of disorders have recently been published. Despite DBS being non-ablative and minimally invasive, numerous complications and side effects have been recorded. In particular, concerning the growing interest in novel indications for DBS, an enthusiastic approach has put neurosurgeons at risk of underestimating some of the complications that might be associated with specific characters of the treated disease.

OBJECTIVE

Our objective was to evaluate hardware failures and rates of infective complications in correlation to the different indications to DBS, in order to ascertain whether DBS in Tourette syndrome (TS) is characterized by specific risks and pitfalls.

METHODS

We retrospectively reviewed our experience of 531 procedures on 272 patients treated for various movement disorders, among which 39 patients were treated for conservative treatmentrefractory TS.

RESULTS

A statistically significant association of infective complications was found with the TS subgroup.

CONCLUSIONS

It is our belief that specific behavioral characters of the TS patients may be put into association with this specific complication and need to be considered carefully when indicating DBS as treatment of choice for these patients.

Computed tomography halo sign in pulmonary nodules: frequency and diagnostic value

On computed tomography (CT) scanning, a ground-glass opacity zone surrounding a pulmonary nodule has been named the computed tomography (CT) halo sign. To investigate the frequency and diagnostic value of the CT halo sign, the authors reviewed the CT examinations of 305 patients with proven diseases producing solitary or multiple nodules. The CT halo sign was seen in 22 patients (7%). Eleven patients had a solitary nodule; five patients had multiple nodules; and six patients had nodules associated with areas of pulmonary consolidation, or ground-glass opacity, or both. Solitary nodules were the result of bronchioloalveolar carcinoma (n = 5), tuberculoma (n = 2), squamous cell carcinoma, non-Hodgkin lymphoma, myxovirus infection, and metastasis (n = 1 each). Multiple nodules were the result of metastasis (n = 2), Kaposi sarcoma (n = 2), and Wegener granulomatosis (n = 1). Nodules associated with areas of consolidation or ground-glass opacity were the result of metastasis (n = 2), bronchioloalveolar carcinoma, bronchiolitis obliterans organizing pneumonia, eosinophilic pneumonia, and invasive pulmonary aspergillosis (n = 1 each). The data showed that the CT halo sign is a nonspecific finding. It is known that in immunocompromised patients the CT halo sign should suggest invasive pulmonary aspergillosis, Kaposi sarcoma, and lymphoproliferative pulmonary disorders. However, in immunocompetent patients, the authors found that a solitary nodule with the CT halo sign and pseudocavitations has a high likelihood of being a bronchioloalveolar carcinoma.

Air-space pattern in lung metastasis from adenocarcinoma of the GI tract

PURPOSE

We retrospectively reviewed a series of proven lung metastasis to evaluate the frequency and CT features of metastases showing an air-space (lepidic) pattern of growth.

METHOD

CT examinations of 65 patients with proven lung metastasis from GI carcinomas were reviewed by three observers. Four CT features were used to classify lesions as air-space metastases: (a) air-space nodules; (b) parenchymal consolidation containing air bronchogram and/or showing angiogram sign; (c) focal or extensive ground-glass opacities; and (d) nodules(s) with a "halo" sign.

RESULTS

Six of 65 patients showed air-space metastases: three from pancreatic carcinoma, two from colonic carcinoma, and one from jejunal carcinoma. In one case, metastasis appeared as extensive parenchymal consolidation associated with ground-glass opacities; in one as an area of ground-glass opacity; in one as an extensive parenchymal consolidation with air bronchogram; in one as parenchymal consolidations with angiogram sign and multiple nodules, some of these with halo sign; in one as air-space nodules and patchy air-space consolidations; and in one as a solitary nodule with halo sign.

CONCLUSION

Our study shows that air-space lung metastasis from GI carcinomas is uncommon but not rare. On CT as well as microscopically, differential diagnosis between air-space metastasis and bronchioloalveolar carcinoma may be impossible.

MRI Tractography of Corticospinal Tract and Arcuate Fasciculus in High-Grade Gliomas Performed by Constrained Spherical Deconvolution: Qualitative and Quantitative Analysis

BACKGROUND AND PURPOSE

MR imaging tractography is increasingly used to perform noninvasive presurgical planning for brain gliomas. Recently, constrained spherical deconvolution tractography was shown to overcome several limitations of commonly used DTI tractography. The purpose of our study was to evaluate WM tract alterations of both the corticospinal tract and arcuate fasciculus in patients with high-grade gliomas, through qualitative and quantitative analysis of probabilistic constrained spherical deconvolution tractography, to perform reliable presurgical planning.

MATERIALS AND METHODS

Twenty patients with frontoparietal high-grade gliomas were recruited and evaluated by using a 3T MR imaging scanner with both morphologic and diffusion sequences (60 diffusion directions). We performed probabilistic constrained spherical deconvolution tractography and tract quantification following diffusion tensor parameters: fractional anisotropy; mean diffusivity; linear, planar, and spherical coefficients.

RESULTS

In all patients, we obtained tractographic reconstructions of the medial and lateral portions of the corticospinal tract and arcuate fasciculus, both on the glioma-affected and nonaffected sides of the brain. The affected lateral corticospinal tract and the arcuate fasciculus showed decreased fractional anisotropy (z = 2.51, n = 20, P = .006; z = 2.52, n = 20, P = .006) and linear coefficient (z = 2.51, n = 20, P = .006; z = 2.52, n = 20, P = .006) along with increased spherical coefficient (z = -2.51, n = 20, P = .006; z = -2.52, n = 20, P = .006). Mean diffusivity values were increased only in the lateral corticospinal tract (z = -2.53, n = 20, P = .006).

CONCLUSIONS

In this study, we demonstrated that probabilistic constrained spherical deconvolution can provide essential qualitative and quantitative information in presurgical planning, which was not otherwise achievable with DTI. These findings can have important implications for the surgical approach and postoperative outcome in patients with glioma.

Single-phase dual-energy CT urography in the evaluation of haematuria

AIM

To assess the value of a single-phase dual-energy computed tomography (DECT) urography protocol with synchronous nephrographic-excretory phase enhancement and to calculate the potential dose reduction by omitting the unenhanced scan.

MATERIALS AND METHODS

Eighty-four patients referred for haematuria underwent CT urography using a protocol that included single-energy unenhanced and dual-energy contrast-enhanced with synchronous nephrographic-excretory phase scans. DECT-based images [virtual unenhanced (VUE), weighted average, and colour-coded iodine overlay] were reconstructed. Opacification degree by contrast media of the upper urinary tract, and image quality of virtual unenhanced images were independently evaluated using a four-point scale. The diagnostic accuracy in detecting urothelial tumours on DECT-based images was determined. The dose of a theoretical dual-phase single-energy protocol was obtained by multiplying the effective dose of the unenhanced single-energy acquisition by two. Radiation dose saving by omitting the unenhanced scan was calculated.

RESULTS

The degree of opacification was scored as optimal or good in 86.9% of cases (k = 0.72); VUE image quality was excellent or good in 83.3% of cases (k = 0.82). Sensitivity, specificity, positive predictive value, and negative predictive value for urothelial tumours detection were 85.7, 98.6, 92.3, and 97.1%. Omission of the unenhanced scan led to a mean dose reduction of 42.7 ± 5%.

CONCLUSION

Single-phase DECT urography with synchronous nephrographic-excretory phase enhancement represents an accurate "all-in-one'' approach with a radiation dose saving up to 45% compared with a standard dual-phase protocol.

Usefulness of power Doppler and contrast-enhanced sonography in the differentiation of hyperechoic renal masses

BACKGROUND

In a prospective study, we compared power Doppler with and without contrast medium in the depiction of vascularity for the characterization of hyperechoic renal lesions.

METHODS

Forty-one hyperechoic renal expansive lesions (29 benign, 12 malignant) in 32 patients were studied with power-Doppler ultrasonography before and after administration of an echo-enhancing agent (Levovist Schering AG, Berlin, Germany). Vascular architecture of the lesions was categorized into five different patterns.

RESULTS

Power Doppler ultrasonography showed vascular structures in 25 lesions. The study enhanced with Levovist showed vascularity in eight of 16 lesions not seen on the unenhanced study. The characterization of vascular patterns with unenhanced power Doppler ultrasonography improved diagnostic accuracy compared with gray-scale ultrasonography (59% vs. 32%). The combination of B mode and power Doppler produced even greater diagnostic accuracy (78%), independent of the administration of echo-enhancing agent. Levovist administration was useful in the differential diagnosis between pseudotumor and neoplasm.

CONCLUSION

The use of sonographic contrast agent did not increase the diagnostic accuracy of power Doppler in the differential diagnosis of hyperechoic renal lesions but was advantageous for the characterization of suspected pseudomasses.

Ground-glass attenuation in nodular bronchioloalveolar carcinoma: CT patterns and prognostic value

PURPOSE

The purpose of our study was to assess the CT patterns and prognostic value of ground-glass attenuation in nodular bronchioloalveolar carcinoma (BAC).

METHOD

We retrospectively reviewed CT examinations of 22 patients with 24 nodular BACs who underwent surgery. CT and pathologic findings were analyzed and correlated with postoperative course of disease.

RESULTS

We detected five patterns of ground-glass attenuation associated with nodular BAC: pure ground-glass nodule (n = 1), ground-glass nodule with superimposed lymphangitis (n = 1), nodule with mixed areas of ground-glass attenuation and consolidation (n = 2), ground-glass halo around nodule (halo sign) (n = 3), and nodule associated with a plurisegmental area of ground-glass attenuation (n = 1). Two patients with the halo sign and a third patient with a plurisegmental area of ground-glass attenuation rapidly developed diffuse pulmonary disease by bronchogenic spread and died a few months after surgery.

CONCLUSION

Our series demonstrates that focal BAC may progress to diffuse pulmonary involvement by bronchogenic spread. The presence of a large area of ground-glass attenuation associated with a nodular BAC might be the CT sign of an aggressive biologic behavior. In these cases there is a high likelihood for diffuse disease to develop from bronchogenic spread.

Carcinomatous solitary pulmonary nodules: evaluation of the tumor-bronchi relationship with thin-section CT

To investigate the value of computed tomography (CT) for depicting the relationship between carcinomatous solitary pulmonary nodules and the bronchial tree and predicting the results of various bronchoscopic biopsy techniques, the authors retrospectively reviewed CT scans from 27 consecutive patients with solitary pulmonary nodules associated with a positive bronchus sign. All patients underwent bronchoscopy and transbronchial biopsy. Macroscopic demonstration of the tumor-bronchi relationship was obtained in 18 patients. Five basic types of tumor-bronchus relationships were identified with CT: (a) bronchus cut off by the tumor, (b) bronchus contained within the tumor, (c) bronchus compressed by the tumor, (d) thickening and smooth narrowing of the bronchus leading to the tumor, and (e) thickening and irregular narrowing of the bronchus leading to the tumor. The diagnostic yield of transbronchial forceps biopsy and bronchial brushing was significantly higher in nodules characterized by a cut-off or contained bronchus. Transbronchial needle aspiration was performed in six patients, and results were positive in five, all of whom had a compressed or thickened bronchus. These results confirm that yield of transbronchial biopsy is determined by the type of tumor-bronchus relationship and the biopsy technique performed.

Physical activity volume in relation to risk of atrial fibrillation. A non-linear meta-regression analysis

Background Light physical activity is known to reduce atrial fibrillation risk, whereas moderate to vigorous physical activity may result in an increased risk. However, the question of what volume of physical activity can be considered beneficial remains poorly understood. The scope of the present work was to examine the relation between physical activity volume and atrial fibrillation risk. Design A comprehensive systematic review was performed following the PRISMA guidelines. Methods A non-linear meta-regression considering the amount of energy spent in physical activity was carried out. The first derivative of the non-linear relation between physical activity and atrial fibrillation risk was evaluated to determine the volume of physical activity that carried the minimum atrial fibrillation risk. Results The dose-response analysis of the relation between physical activity and atrial fibrillation risk showed that physical activity at volumes of 5-20 metabolic equivalents per week (MET-h/week) was associated with significant reduction in atrial fibrillation risk (relative risk for 19 MET-h/week = 0.92 (0.87, 0.98). By comparison, physical activity volumes exceeding 20 MET-h/week were unrelated to atrial fibrillation risk (relative risk for 21 MET-h/week = 0.95 (0.88, 1.02). Conclusion These data show a J-shaped relation between physical activity volume and atrial fibrillation risk. Physical activity at volumes of up to 20 MET-h/week is associated with reduced atrial fibrillation risk, whereas volumes exceeding 20 MET-h/week show no relation with risk.

Contrast-enhanced power Doppler US in the diagnosis of renal pseudotumors

The term "pseudotumor" is used to refer to several anatomic variants that can simulate a renal mass, the most frequent of which are hypertrophied column of Bertin, persistence of fetal lobation, and the dromedary or splenic hump. We describe the findings of power Doppler US after the ultrasound contrast agent (Levovist, Schering, Berlin, Germany) administration in 4 patients with a renal focal lesion in whom gray-scale and baseline power Doppler US was not able to certainly differentiate pseudotumor from neoplasm.

Detection of preclinical impairment of myocardial function in rheumatoid arthritis patients with short disease duration by speckle tracking echocardiography

BACKGROUND

Subclinical cardiac involvement diagnosis is important for long term management of rheumatoid arthritis (RA) patients. Recently, 2D speckle tracking echocardiography (STE) allows non invasive and angle-independent measurement of left ventricular (LV) dimensions and regional myocardial strain (ε). The aim of this study was to assess whether STE can be useful to detect subclinical cardiac involvement in RA patients.

METHODS

We studied 22 RA patients (10 M, 12 F, aged 46 ± 12 years) without clinical evidence of coronary artery disease (CAD) and 20 healthy controls matched for age and sex by STE. LV end-systolic longitudinal and radial ε from apical 4-chamber view were analyzed using available software (QLAB 6.0).

RESULTS

Standard echo and Doppler parameters did not differ between the 2 groups. Tissue Doppler Imaging (TDI) showed a significant reduction of S', E' and E'/A' ratio from the basal septum and lateral mitral annulus in RA patients. LV end-systolic radial and longitudinal ε of basal-lateral, basal- and mid-septal, mid-lateral and apical segments were significantly reduced compared to controls.

CONCLUSIONS

Our data indicate that LV end-systolic radial and longitudinal ε are reduced in RA patients without CAD despite normal standard echo. Non invasive evaluation of LV function by STE appears to be useful to detect subclinical cardiac involvement in comparison to conventional 2D echoDoppler, representing a promising new modality to follow-up RA patients for cardiac involvement.

Role of psoriasis as independent predictor of cardiovascular disease: a meta-regression analysis

BACKGROUND

Despite the proved association between psoriasis and cardiovascular risk exposure, there are no data about the role of psoriasis as an independent predictor of such risk. The aim of this study was to investigate whether any association between psoriasis and excess cardiovascular risk exposure is independent from confounding factors.

METHODS

Meta-analysis and meta-regression analysis were performed using data extracted from observational studies (identified by MEDLINE, EMBASE and CINAHL) investigating the relationship between psoriasis and cardiovascular disease with at least 6 points on the New Castle-Ottawa quality scale. Two reviewers with methodological expertise conducted data extraction independently.

RESULTS

Thirteen studies including patients with psoriasis showed an increased risk of cardiovascular disease (RR=1.24 [1.18-1.31]; P=0.0001). These patients still presented a significantly larger cardiovascular risk in the presence of smoking (RR=1.14 [CI=1.13-1.15] P<0.0001), obesity (RR=1.11 [CI=1.07-1.14] P=0.0003) and hyperlipidemia (RR=1.05 [CI=1.03-1.07] P=0.0006), but not in the presence of hypertension (RR=1.03 [CI=0.98-1.09] P=0.4647) and diabetes (RR=0.95 [CI=0.90-1.01] P=0.6502).

CONCLUSIONS

Patients with psoriasis carry an about 25% increased relative risk of cardiovascular disease. This risk appears to be independent of smoking, obesity and hyperlipidemia.

Role of Right Ventricle and Dynamic Pulmonary Hypertension on Determining ΔVO 2 /ΔWork Rate Flattening

Background—

Several cardiovascular diseases are characterized by an impaired O 2 kinetic during exercise. The lack of a linear increase of Δoxygen consumption (V O 2 )/ΔWork Rate (WR) relationship, as assessed by expired gas analysis, is considered an indicator of abnormal cardiovascular efficiency. We aimed at describing the frequency of ΔVO 2 /ΔWR flattening in a symptomatic population of cardiac patients, characterizing its functional profile, and testing the hypothesis that dynamic pulmonary hypertension and right ventricular contractile reserve play a major role as cardiac determinants.

Methods and Results—

We studied 136 patients, with different cardiovascular diseases, referred for exertional dyspnoea. Cardiopulmonary exercise test combined with simultaneous exercise echocardiography was performed using a symptom-limited protocol. ΔVO 2 /ΔWR flattening was observed in 36 patients (group A, 26.5% of population) and was associated with a globally worse functional profile (reduced peak V O 2 , anaerobic threshold, O 2 pulse, impaired VE/VCO 2 ). At univariate analysis, exercise ejection fraction, exercise mitral regurgitation, rest and exercise tricuspid annular plane systolic excursion, exercise systolic pulmonary artery pressure, and exercise cardiac output were all significantly ( P <0.05) impaired in group A. The multivariate analysis identified exercise systolic pulmonary artery pressure (odds ratio, 1.06; confidence interval, 1.01–1.11; P =0.01) and exercise tricuspid annular plane systolic excursion (odds ratio, 0.88; confidence interval, 0.80–0.97; P =0.01) as main cardiac determinants of ΔVO 2 /ΔWR flattening; female sex was strongly associated (odds ratio, 6.10; confidence interval, 2.11–17.7; P <0.01).

Conclusions—

In patients symptomatic for dyspnea, the occurrence of ΔVO 2 /ΔWR flattening reflects a significantly impaired functional phenotype whose main cardiac determinants are the excessive systolic pulmonary artery pressure increase and the reduced peak right ventricular longitudinal systolic function.

Urgent ureteroscopy as first-line treatment for ureteral stones: a meta-analysis of 681 patients

There are various recent studies on the use of ureteroscopy and debate on whether this should be the first-line treatment for patients with ureteral stones. The aim of this meta-analysis was to understand the role of this surgical procedure in the emergency setting as first-line treatment and to compare the immediate procedure with a delayed one in terms of stone-free rate and complications. A bibliographic search covering the period from January 1980 to March 2010 was conducted in PubMed, MEDLINE and EMBASE. This analysis is based on the six studies found that fulfilled the predefined inclusion criteria. A total of 681 participants were included. The number of participants in each of the studies considered ranged from 27 to 244 (mean 113). Stone-free rates were 81.9% (72.0-91.8) for the proximal ureter, 87.3% (82.6-92.0) for the mid-ureter, 94.9% (92.1-97.6) for the distal ureter and 89.5% (86.5-92.5) overall according to the logistic regression applied. These values are not statistically significantly different from those reported in the AUA and EAU guidelines. The stone diameter seems to affect the stone-free rate. An increase of the stone diameter of 1 mm beyond 8 mm corresponded to a reduction of stone-free rate of 5% (2.4-8.0) and 8.1% (3.8-12.1) for the distal and proximal ureters, respectively. There is a complete lack of information in international guidelines on the ureteroscopic management of ureteral stones in an emergency setting and the currently available results are dispersed in a few studies in the literature. The rationale for using emergency ureteroscopy is more rapid stone clearance and relief from colic pain. According to our meta-analysis, immediate ureteroscopy for ureteral stone colic seems to be a safe treatment with a high success rate. This evidence will be validated by further randomized studies, with larger series of patients.

Association between a school-based intervention and adiposity outcomes in adolescents: The Italian "EAT" project

OBJECTIVE

To evaluate whether a school-based multicomponent educational program could improve adiposity measures in middle-school adolescents.

METHODS

A non-randomized controlled pilot study was conducted in six state middle schools (487 adolescents, 11-15 years) in townships in an urban area around Milan, three schools (n = 262 adolescents) being assigned to the intervention group and three schools (n = 225 adolescents) to the control group. The two-school-year intervention included changes in the school environment (alternative healthy vending machines, educational posters) and individual reinforcement tools (school lessons, textbook, text messages, pedometers, re-usable water bottles). The main outcome measure was change in BMI z-score. The secondary outcomes were changes in waist-to-height ratio (WHtR) and behavioral habits.

RESULTS

The intervention was associated with a significant difference in BMI z-score (-0.18 ± 0.03, P<0.01) and in WHtR (-0.04 ± 0.002, P < 0.001), after controlling for baseline covariates. Subgroup analysis showed the maximum association between the intervention and the difference in BMI z-score for girls with overweight/obesity. Physical activity increased and consumption of sugar-sweetened beverages and high-energy snacks decreased in adolescents after the intervention.

CONCLUSIONS

A school-based multicomponent intervention conducted at both environmental and individual levels may be effective for reducing adiposity measures mainly in adolescents with overweight/obesity.

Chronic infiltrative lung diseases: value of gadolinium-enhanced MRI in the evaluation of disease activity--early report

STUDY OBJECTIVE

To determine the value of gadolinium-enhanced MRI in the assessment of disease activity in chronic infiltrative lung diseases (CILDs).

DESIGN

Retrospective study.

SETTING

University hospital.

MATERIALS AND METHODS

Twenty-five consecutive patients with CILD were studied. The following diseases were diagnosed: sarcoidosis (n = 10), bronchiolitis obliterans organizing pneumonia (n = 3), usual interstitial pneumonia (n = 4), radiation pneumonia (n = 2), desquamative interstitial pneumonia (n = 1), rheumatoid lung (n = 1), vasculitis (n = 1), alveolar proteinosis (n = 1), bronchioloalveolar carcinoma (n = 1), and chronic eosinophilic pneumonia (n = 1). In each patient, the disease activity was assessed by one or more of the following studies: BAL (n = 18), gallium-radioisotope lung scanning (n = 6), serum angiotensin-converting enzyme assay (n = 10), and open lung biopsy (n = 4). T1-weighted breath-hold MRI studies were obtained before and after IV injection of gadolinium. The MRI examinations were analyzed to assess the presence or absence of lesional enhancement.

RESULTS

The presence of enhanced pulmonary lesions was seen in 14 patients. All of these patients had active disease. Of the 17 patients with active disease, 14 had enhanced lesions, and 3 had unenhanced lesions. Pulmonary lesions were not enhanced in any patients with inactive disease. The difference was statistically significant (Fisher Exact Test, p < 0.05).

CONCLUSION

Gadolinium-enhanced MRI may prove to be a useful tool in assessing disease activity in CILDs.

The role of the ostiomeatal unit anatomic variations in inflammatory disease of the maxillary sinuses

OBJECTIVE

The purpose of the study was to determine the correlation between bony anatomic variations of the ostiomeatal unit (OMU) and chronic maxillary sinusitis. The study was based on the hypothesis that the mucosal contact caused by the variations represents the critical factor in increasing the risk of maxillary sinusitis.

MATERIALS AND METHODS

Thin section high resolution computerised tomography (CT) examinations of the paranasal sinuses in 73 consecutive patients with 113 anatomic variations of the OMU were retrospectively reviewed. The following CT features were assessed: (1) Type of anatomic variations, (2) presence of a mucosal contact in the OMU and (3) presence of maxillary disease. Statistical evaluation was carried out using chi 2-test.

RESULTS

The following bony anatomic variations were found: Concha bullosa (67 cases), abnormalities of the uncinate process (18 cases), Haller's cells (24 cases) and large ethmoidal bulla (four cases). Only 52 of the 113 anatomic variations were associated with ipsilateral maxillary disease (mucosal thickening, mucous retention cysts, polyps, retained secretions). Of 113 variations, 44 caused a mucosal contact, 35 of these were associated with maxillary abnormalities, while in nine cases there were no pathologic changes. Of 69 variations, 17 did not cause mucosal contact (P < 0.05).

CONCLUSION

Our data shows that, in the presence of anatomic bony variations, a contact between the mucosal surface of the OMU is valuable in predicting the likelihood of a maxillary inflammatory disease.

Physical training and noninvasive ventilation in COPD patients: a meta-analysis

BACKGROUND

Exercise training improves both exercise tolerance and quality of life in patients with COPD. The intensity of exercise training is crucial to achieve a true physiologic effect. However, in COPD patients, exertional dyspnea and leg fatigue mean that the patient cannot maintain intensity of training for enough time to yield a physiologic training effect. The use of noninvasive ventilation (NIV) support has been proposed as an alternative strategy to improve exercise tolerance and respiratory and cardiovascular performances. The first aim of our meta-analysis was to evaluate exercise training with NIV in terms of physiologic effects after the completion of a pulmonary rehabilitation program. The second aim was to investigate the dose-response relationship between physical improvement and training intensity.

METHODS

Literature research was performed using MEDLINE, Embase, and CINAHL. Meta-analysis and meta-regressions were performed using random effects models.

RESULTS

Eight studies provided a proper description of a training schedule in stable COPD patients. A similar effect between NIV and placebo was observed for the outcomes considered despite differences between studies. However, subjects experienced a relevant and statistically significant improvement after rehabilitation for almost all of the outcomes considered. Heart rate (6 beats/min [95% CI 0.94-11.01], P = .02), work load (9.73 W [95% CI 3.78-15.67], P < .001), and oxygen consumption (242.11 mL/min [95% CI 154.93-329.9], P < .001) significantly improved after training. Improvements in heart rate and work load were significantly correlated to training intensity.

CONCLUSIONS

Given the small number of available studies, the small sample sizes, and the complete absence of power calculation, we think that this topic deserves a more in-depth investigation. Randomized clinical trials with larger sample sizes based on statistical power calculations and designed to investigate the effect of training duration and intensity on rehabilitation are needed to confirm results in this important field.