Magnetic resonance imaging provides a good representation of cartilage and subchondral bone thickness, supporting its use in the study and clinical diagnosis of osteochondral structure and alteration.
Scintigraphy is useful in assessing GER in PEG-fed patients. We also note that GER is a major problem in patients with PEG, especially in those with neurological dysphagia.
Chronic laminitis is a severe disease affecting the equine digit. It was hypothesized that magnetic resonance (MR) imaging would improve visualization of structures within the foot and pathology associated with chronic laminitis. This study aimed to describe the MR imaging findings in chronic laminitis, compare different pulse sequences for visualization of pathology, and to compare MR imaging with standard radiography. Twenty (10 forelimb, 10 hindlimb) cadaver limbs from 10 horses clinically diagnosed with chronic laminitis (group L) and 10 limbs without laminitis (group N) were used. Lateromedial radiographs and sagittal and transverse MR images of the foot were obtained. Radiographs and MR images were evaluated for anatomic definition and evidence of pathology. Dorsal hoof wall thickness and angle of rotation and displacement distance of the distal phalanx were measured. Comparisons were made between group L and N, forelimb and hindlimb within each horse, and MR imaging and radiography. Features consistently noted with MR images in group L, but not detected using radiography, included laminar disruption, circumscribed areas of laminar gas, laminar fluid, and bone medullary fluid. Other findings seen only on MR images included increased size and number of vascular channels, alterations in the corium coronae, and distal interphalangeal joint distension. Magnetic resonance imaging allowed better definition of laminar gas lines and P3 surface irregularity observed on radiographs. Based on measurements, group L had a greater angle of rotation, distal displacement, and dorsal hoof wall thickness than group N; forelimb hoof wall thickness was greater than hindlimb; and distal displacement and hoof wall thickness measurements were smaller using MR imaging than radiography, but had a similar pattern. It is concluded that there are features of chronic laminitis consistently observed using MR imaging and that these may be additional to features observed radiographically.
Introduction We used phase-3 CONVERT trial data to investigate the impact of fludeoxyglucose F 18 ( 18 F-FDG) positron emission tomography (PET)/computed tomography (CT) in SCLC. Methods CONVERT randomized patients with limited-stage SCLC to twice-daily (45 Gy in 30 fractions) or once-daily (66 Gy in 33 fractions) chemoradiotherapy. Patients were divided into two groups in this unplanned analysis: those staged with conventional imaging (contrast-enhanced thorax and abdomen CT and brain imaging with or without bone scintigraphy) and those staged with 18 F-FDG PET/CT in addition. Results Data on a total of 540 patients were analyzed. Compared with patients who underwent conventional imaging (n = 231), patients also staged with 18 F-FDG PET/CT (n = 309) had a smaller gross tumor volume ( p = 0.003), were less likely to have an increased pretreatment serum lactate dehydrogenase level ( p = 0.035), and received more chemotherapy ( p = 0.026). There were no significant differences in overall (hazard ratio = 0.87, 95% confidence interval: 0.70–1.08, p = 0.192) and progression-free survival (hazard ratio = 0.87, 95% confidence interval: 0.71–1.07], p = 0.198) between patients staged with or without 18 F-FDG PET/CT. In the conventional imaging group, we found no survival difference between patients staged with or without bone scintigraphy. Although there were no differences in delivered radiotherapy dose, 18 F-FDG PET/CT–staged patients received lower normal tissue (lung, heart, and esophagus) radiation doses. Apart from a higher incidence of late esophagitis in patients staged with conventional imaging (for grade ≥1, 19% versus 11%; [ p = 0.012]), the incidence of acute and late radiotherapy-related toxicities was not different between the two groups. Conclusion In CONVERT, survival outcomes were not significantly different in patients staged with or without 18 F-FDG PET/CT. However, this analysis cannot support the use or omission of 18 F-FDG PET/CT owing to study limitations.
Colonoscopy is the primary screening procedure for colorectal cancer and car− ries very low risk of complications (be− tween 0.3 % and 0.35 %) [1]. It is estimated that 1.69 million colonoscopies are per− formed each year in the USA alone [2]. The most common complications are in− traluminal gastrointestinal bleeding and colonic perforation [1]. Infrequently, he− moperitoneum occurs, mostly involving damage to the spleen. We present a case of hemoperitoneum following colonosco− py without splenic injury. A 59−year−old female presented to our emergency department following a syn− copal episode 12 hours after an unre− markable screening colonoscopy. Despite minor abdominal discomfort noted after the procedure, she resumed her normal activities. Pertinent history included a prior appendectomy. Besides pallor and minimal abdominal tenderness to palpa− tion, physical exam was within normal limits. Laboratory tests showed a hemo− globin concentration of 10.4 g/dL and a hematocrit of 28.8 %. Leukocyte count, electrolytes, blood urea nitrogen, and creatinine were normal. Stool was guaiac negative. An abdominal radiograph ex− cluded pneumoperitoneum (l " Fig. 1). Computed tomography (CT) scans of the abdomen and pelvis showed moderate amounts of free fluid demonstrating a density level suggestive of blood. The spleen appeared normal and there was no free air or extravasation of contrast from the bowel (l " Fig. 2 a, b). She was monitored for further bleeding and was subsequently discharged after 6 days. Intra−abdominal hemorrhage, a rare com− plication of colonoscopy, is most com− monly reported in conjunction with splenic injury. Other documented causes of hemoperitoneum after colonoscopies include a torn mesenteric vessel, a rup− tured epiploic appendix, and a necrosed intestinal leiomyosarcoma [3 ± 5]. Due to the lack of other findings, it was speculat− ed that the etiology in this case was a torn mesenteric vein. Intra−abdominal adhe− sions from her appendectomy could have contributed. Endoscopy_UCTN_Code_CPL_1AJ_2ABHemoperitoneum after colonoscopy Fig. 1 Abdominal radiograph centered at the diaphragm ex− cludes the presence of pneumoperitoneum.
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