Small bowel obstruction and large bowel obstruction account for approximately 20% of cases of acute abdominal surgical conditions. The role of the radiologist is to answer several key questions: Is obstruction present? What is the level of the obstruction? What is the cause of the obstruction? What is the severity of the obstruction? Is the obstruction simple or closed loop? Is strangulation, ischemia, or perforation present? In this presentation, the radiologic approach to and imaging findings of patients with known or suspected bowel obstruction are presented.
Respiratory syncytial virus (RSV) is the most common cause of acute viral lower respiratory disease in infants and young children, followed by human parainfluenza virus type 3 (HPIV3) as the second most important viral respiratory pathogen. In the United States, RSV and HPIV3 are responsible for approximately one-third of all pediatric respiratory tract disease leading to hospitalization (13,20,45), and RSV alone is estimated to account for between 73,000 and 126,000 annual hospitalizations of infants younger than 1 year of age (51). Worldwide, acute lower respiratory tract disease is the leading cause of mortality due to infectious diseases (63), and in infants and young children RSV is the most commonly isolated viral pathogen in this disease entity (59). To reduce the burden of disease caused by RSV and HPIV3, vaccines that are safe and immunogenic are clearly needed.The first RSV vaccine candidate, a formalin-inactivated vaccine developed in the 1960s, failed to provide protection against RSV infection and resulted in immune-mediated enhanced disease upon subsequent infection by wild-type RSV (40). Enhancement of RSV disease does not occur after natural RSV infection and has not been seen following immunization with an intranasally administered, live attenuated RSV vaccine candidate (65). This is an important factor in favor of a topically administered live attenuated RSV vaccine. To date, several live attenuated RSV vaccine candidates have been evaluated in clinical trials (33,39,64,65), but a licensed RSV vaccine is still not available. The most challenging aspect of developing a live attenuated RSV vaccine is to achieve an appropriate balance between attenuation and immunogenicity in the young infant, in whom immune responses are reduced due to immunologic immaturity and the immunosuppressive effects of maternally derived virus-specific serum immunoglobulin G (65). Mucosal immunization provides a partial escape from immunosuppression by serum antibodies (44), and therefore topically administered live attenuated vaccines seem ideal for immunization of young infants. However, all live attenuated RSV vaccine candidates tested to date have been either overattenuated and insufficiently immunogenic (34, 64) or underattenuated (36, 65) in this age group.Protection against reinfection with RSV and HPIV3 is mainly conferred by serum and mucosal antibodies directed against their viral surface glycoproteins (16). The RSV G and
Multidetector-row computed tomography (MDCT) has become the primary imaging test for the staging and follow-up of most malignancies that originate outside of the central nervous system. Technical advances in this imaging technique have led to significant improvement in the detection of metastatic disease to the liver. An unintended by-product of this improving diagnostic acumen is the discovery of incidental hepatic lesions in oncology patients that in the past remained undetected. These ubiquitous, incidentally identified hepatic lesions have created a management dilemma for both clinicians and radiologists: are these lesions benign or do they represent metastases? Naturally, the answer to this question has profound prognostic and therapeutic implications. In this review, guidelines concerning the diagnosis and management of some of the more common hepatic incidental lesions detected in patients with extrahepatic malignancies are presented.
Technical advances in cross-sectional imaging have led to the discovery of incidental cystic pancreatic lesions in the oncology and non-oncology population that in the past remained undetected. These lesions have created a diagnostic and management dilemma for both clinicians and radiologists: should these lesions be ignored, watched, aspirated, or removed? In this review, recommendations concerning the assessment of the more common pancreatic cystic incidental lesions are presented.
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