Cutaneous malignant melanoma is one of the most lethal and widely metastasising cancers with unpredictable pathways of spread. One of the most significant factors associated with survival in patients who have distant metastases is the number of organ sites involved. Innovative treatment options are now available for metastatic melanoma, and diagnostic imaging has become crucial for accurate staging and restaging of disease. The objective of this pictorial review is to illustrate the imaging spectrum of metastatic cutaneous malignant melanoma including both the common and the relatively ubiquitous sites of involvement using both conventional cross-sectional and metabolic molecular imaging. This review also highlights the importance of combining multiple imaging methods for accurate staging of metastatic melanoma.
Background Acquired uterine arterial anomalies, including uterine artery pseudoaneurysms (UAP), arteriovenous malformations (AVMs) and arteriovenous fistulae (AFVs), are rare presenting causes of abnormal uterine bleeding. Timely diagnosis is essential for safe and effective treatment, avoiding life-threatening haemorrhage resulting from erroneous uterine curettage due to misdiagnosing these as other more common differentials. Main text This pictorial review discusses the ultrasound (USG), CT and MRI features of various acquired uterine vascular abnormalities with angiographic correlates. Conclusion Acquired uterine arteriovenous injuries are a fundamental cause of dysfunctional intractable bleeding recalcitrant to traditional conservative management. Endovascular transcatheter uterine artery embolisation is an increasingly popular and safe mode of treatment, especially in young patients desiring to have the option of future pregnancies, with lesser morbidity and in-hospital stay duration.
Radiofrequency ablation (RFA) is a revolutionary procedure in the practice of pain management that can be used in the treatment of sacroiliac joint pain syndromes. It is a technology that uses radiofrequency needle probes to create lesions by way of localized tissue destruction. It is indicated for patients with chronic sacroiliac joint pain who have had a positive response to a lateral branch block. This procedure typically provides at least 6 and up to 12 months of significant pain relief and can be repeated. Practitioners should be well versed in the different evolving methods for RFA as well as its evidence, relevant anatomy, the technology used in RFA, and the complications that may occur with this procedure and how to prevent them. This chapter explores these principles and presents the relevant findings from the literature for this innovative procedure for sacroiliac joint pain.
Spinal epidural lipomatosis (SEL) is a rare condition in which fat accumulates in the epidural space. Patients may be asymptomatic or present with neurologic symptoms if the spinal cord is compressed. Based on the pathophysiology of this condition, there are theorized effects that suggest a contraindication to epidural anesthesia. Due to the rarity of the condition, there is a lack of significant evidence in the literature regarding the efficacy of epidural analgesia or related complications in these patients. Herein, we have presented a patient with a prior diagnosis of spinal epidural lipomatosis and her course of anesthetic management during labor.
Objective: To compare the diagnostic accuracy of MRI and CT for detection of acute cerebral haemorrahge. Study Design: Comparative Study Place and Duration: Mohiuddin Islamic Teaching Hospital Mirpur AJK for period of six months from 1st August, 2020 to 31stJanuary, 2021. Methodology: A total of 20 patients of both genders with age of 25 years and onward with intracerebral hemorrhage who underwent MRI following CT in the first 6 hours of onset and last known well time and admission in stroke center were included in the study. The follow up time duration for both the scans was 24 hours to 48hours. The Mc-Nemar test was used to determine the comparison between MRI and CT on contingency table. Results: The mean age of the participants was 53.26±2.45. The frequency of the male participants was 13(65%) and that of female was 7(35%). All cases were of acute ICH 20(100%). The number of positive cases on MRI and CT scan was 17, while the frequency of positive cases on MRI and negative on CT scan was 3 with the p- value of less than 0.001 and a confidence interval of 95%. (See table 1 for details). The interrater reliability for acute ICH on MRI is from 0.72 to 0.80 on k statistics. The interrater reliability for acute ICH on CT is from 0.83 to 0.92. Conclusion: It is concluded that the findings of MRI scan were more accurate than CT in the detection of acute intracerebral hemorrhage. Keywords: Acute Cerebral Hemorrhage, MRI, CT, Diagnostic Accuracy
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