Modified approach to the characterization of adrenal nodules using a standard abdominal magnetic resonance imaging protocol

Abstract Objective: To describe a modified approach to the evaluation of adrenal nodules using a standard abdominal magnetic resonance imaging protocol. Materials and Methods: Our sample comprised 149 subjects (collectively presenting with 132 adenomas and 40 nonadenomas). The adrenal signal intensity index was calculated. Lesions were grouped by pattern of enhancement (PE), according to the phase during which the wash-in peaked: arterial phase (type 1 PE); portal venous phase (type 2 PE); and interstitial phase (type 3 PE). The relative and absolute wash-out values were calculated. To test for mean differences between adenomas and nonadenomas, Student's t-tests were used. Receiver operating characteristic curve analysis was also performed. Results: The mean adrenal signal intensity index was significantly higher for the adenomas than for the nonadenomas (p < 0.0001). Chemical shift imaging showed a sensitivity and specificity of 94.4% and 100%, respectively, for differentiating adenomas from nonadenomas. Of the adenomas, 47.6%, 48.5%, and 3.9%, respectively, exhibited type 1, 2, and 3 PEs. For the mean wash-in proportions, significant differences were found among the enhancement patterns. The wash-out calculations revealed a trend toward better lesion differentiation for lesions exhibiting a type 1 PE, showing a sensitivity and specificity of 71.4% and 80.0%, respectively, when the absolute values were referenced, as well as for lesions exhibiting a type 2 PE, showing a sensitivity and specificity of 68.0% and 100%, respectively, when the relative values were referenced. The calculated probability of a lipid-poor lesion that exhibited a type 3 PE being a nonadenoma was > 99%. Conclusion: Subgrouping dynamic enhancement patterns yields high diagnostic accuracy in differentiating adenomas from nonadenomas.

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There is a Correlation between Fragility Fractures of the Pelvis and a Circle-Type Morphology of the True Pelvis, but Not with Pelvic Incidence

Gerontology and Geriatric Research ◽

10.31487/j.ggr.2021.01.01 ◽

2021 ◽

pp. 1-6

Author(s):

Matthias Spalteholz ◽

Gulow Jens ◽

Pap Geza

Keyword(s):

Pelvic Incidence ◽

Fragility Fractures ◽

Statistical Correlation ◽

X Ray ◽

Lack Of Information ◽

The Mean ◽

Fracture Types ◽

Type 3

Purpose: Osteoporosis is a major risk factor for the development of fragility fractures of the pelvis (FFP). There is a lack of information about the influence of anatomical conditions such as Pelvic Incidence and Pelvic Ratio (DT/DS ratio) on this kind of fractures. Methods: This is a monocentric retrospective analysis. X-ray images of the lumbar spine and pelvis and 3D-MPR CT reconstructions of the pelvis were analysed to determine Pelvic Incidence (PI) and Pelvic Ratio (PR) in 141 fragility fractures of the pelvis. Statistical analyses were performed to examine the correlation between these spinopelvic parameters and fragility fractures of the pelvis. Results: A total of 141 fragility fractures of the pelvis (14 men = 9.93%, 127 women = 90.07%) were analysed. According to the FFP-classification we recognized FFP type 1 fractures in 19.15%, FFP type 2 in 41.13%, FFP type 3 in 8.51% and FFP type 4 fractures in 32.21%. The mean PI was 58.83º. There was no statistical correlation between PI and fracture types (p=0.81). The mean PR was 1.099. 57 patients (40.43%) demonstrated a DT/DS ratio ≤ 1.06, corresponding to a circle-type morphology. 24 patients (17.02%) demonstrated a DT/DS ratio ≥ 1.18, corresponding to an ellipse-type pelvis. A circle-type pelvis is significantly more often associated with fragility fractures of the pelvis than an ellipse-type morphology (p<0.001). Conclusion: The results of our work demonstrate a strong statistical correlation between the circle-type morphology of the pelvis (PR ≤ 1.06) and fragility fractures of the pelvis. There is no statistical correlation between fragility fractures of the pelvis and Pelvic Incidence.

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Anterior Ethmoidal Artery: A Computed Tomography Analysis and New Classifications

Journal of Neurological Surgery Part B Skull Base ◽

10.1055/s-0039-3400225 ◽

2020 ◽

Author(s):

Mohammad Waheed El-Anwar ◽

Alaa Omar Khazbak ◽

Diaa Bakry Eldib ◽

Hesham Youssef Algazzar

Keyword(s):

Computed Tomography ◽

Skull Base ◽

Frontal Sinus ◽

Ethmoidal Artery ◽

Anterior Ethmoidal Artery ◽

The Mean ◽

Type 3 ◽

Sinus Ostium

Abstract Objective to determine the anterior ethmoidal artery (AEA) anatomy and variations by computed tomography (CT) in adult and their relations to and presents new AEA classifications. Methods One hundred and fifty paranasal CT scans (300 sides) were included. Axial images were acquired with multiplanar reformates to obtain delicate details in coronal and sagittal planes. Results One hundred and forty-four AEAs canal (48%), 293 AEAs foramen (97.7%), and 229 AEAs sulcus could be detected (76.3%). The mean AEA intranasal length was 6.7 ± 1.27 mm (range: 4.24–10.6 mm). The mean angle between AEA and lamina papyracea was 105.49 ± 9.28 degrees (range: 76.41–129.76 degrees). Of them, 95.8% AEAs had an angle with lamina >90 degrees, while 4.2% had angle <90 degrees. The mean angle between AEA and lateral lamella of cribriform plate was 103.95 ± 13.08 degrees (range: 65.57–141.36 degrees). Of them, 87.5% AEAs had an angle >90 degrees and 12.5% had an angle <90 degrees. The mean distance between AEA and skull base was 1.37 ± 1.98 mm (range: 0–8.35 mm). The AEA types in relation to skull base was type 1 (0–2 mm from skull base; 64.6%), type 2 (2–4 mm; 22.2%), type 3 (4–6 mm; 11.1%), and type 4 (>6 mm; 2.1%). The mean distance between the AEA and frontal sinus ostium was 9.17 ± 4.72 mm (range: 0–25.36 mm). AEA classification according to distance from AEA to frontal sinus ostium was 17.4% type 1 (<5 mm), 41.7% type 2 (5–10 mm), 31.9% type 3 (10–15 mm), and 9% type 4 (>15 mm). Conclusion Provided AEA details improve surgeons' awareness of AEA variations in the endoscopic field and can help residents in training.

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Infestation of parasitic rhizocephalan barnacles Sacculina beauforti (Cirripedia, Rhizocephala) in edible mud crab, Scylla olivacea

PeerJ ◽

10.7717/peerj.3419 ◽

2017 ◽

Vol 5 ◽

pp. e3419 ◽

Cited By ~ 7

Author(s):

Khor Waiho ◽

Hanafiah Fazhan ◽

Henrik Glenner ◽

Mhd Ikhwanuddin

Keyword(s):

Mud Crab ◽

Mitochondrial Coi ◽

Normal Individuals ◽

Different Types ◽

Rhizocephalan Barnacles ◽

Commercially Important ◽

The Mean ◽

Type 3

Screening of mud crab genus Scylla was conducted in four locations (Marudu Bay, Lundu, Taiping, Setiu) representing Malaysia. Scylla olivacea with abnormal primary and secondary sexual characters were prevalent (approximately 42.27% of the local screened S. olivacea population) in Marudu Bay, Sabah. A total of six different types of abnormalities were described. Crabs with type 1 and type 3 were immature males, type 2 and type 4 were mature males, type 5 were immature females and type 6 were mature females. The abdomen of all crabs with abnormalities were dented on both sides along the abdomen’s middle line. Abnormal crabs showed significant variation in their size, weight, abdomen width and/or gonopod or pleopod length compared to normal individuals. The mean body weight of abnormal crabs (type 1–5) were higher than normal crabs with smaller body size, while females with type 6 abnormality were always heavier than the normal counterparts at any given size. Sacculinid’s externa were observed in the abdomen of crabs with type 4 and type 6 abnormalities. The presence of embryos within the externa and subsequent molecular analysis of partial mitochondrial COI region confirmed the rhizocephalan parasite as Sacculina beauforti. Future in-depth descriptions of the life cycle and characteristics of S. beauforti are recommended as it involves a commercially important edible crab species and the effect on human health from the consumption of crabs is of crucial concern.

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Pharmacokinetic Evaluation of a Newly Introduced Von Willebrand Factor Concentrate At Two London Haemophilia Centres

Blood ◽

10.1182/blood.v120.21.3384.3384 ◽

2012 ◽

Vol 120 (21) ◽

pp. 3384-3384

Author(s):

Oliver Hegener ◽

Natasha M Wiles ◽

Anne Wareing ◽

Bella Madan ◽

Steve K Austin

Keyword(s):

Half Life ◽

Individual Variability ◽

Advisory Board ◽

Activity Level ◽

The Mean ◽

Group B ◽

The Uk ◽

Type 3

Abstract Abstract 3384 Introducing new factor concentrates in VWD patients is complicated by VWD subtype and PK variability. Wilate, a VWF concentrate with a 1:1 VWF: FVIII ratio and has not yet been widely used in the UK. We conducted PK studies with Wilate, to determine its efficacy, peak VWF activity and FVIII levels, and clearance in patients with VWD. Where feasible, we compared the data with previously used concentrate (Haemate-P) handling. 17 VWD patients (4 type 1, 6 type 2, 7 type 3) from two London Haemophilia centres were evaluated. The median age was 36 yrs (range 12– 67 yrs); sex M:F 6:11; mean body weight 73 kg (range 39–122 kg). Seven were blood group O, 1 group AB, 4 group A and 4 group B. The mean dose of Wilate administered was 44 iu/kg VWF: RiCoF (range 17–61). VWF activity, VWF antigen and FVIII levels were measured pre- and post for up to 8 hrs. The mean dose of Wilate required to reach target VWF:RiCof activity level of >65 iu/dl in the type 3 VWD was 49.6 iu/kg, and 38.7 iu/kg in type 2 VWD. Of the type 1 patients mean dosing was 43.0 iu/kg. The median peak VWF:RiCoF activity was 82 iu/dl in type 3 and 115 iu/dl in type 2, and 92 iu/dl in type 1. VWF Antigen levels were 116 iu/dl in type 3, and 164 iu/dl in type 2 and 135 iu/dl in type 1. VWF handling in some individuals was suggestive of increased VWF clearance with a half-life below the suggested half-life of 12 hours. This observation indicates the importance of prolonged PK studies in individual cases. As expected, peak FVIII levels were generally higher with Wilate compared to previously used concentrate (94 iu/dl in type 3 and 82 iu/dl in type 2) but the PK profiles between the products were similar, with some inter-individual variability. In conclusion, Wilate achieves adequate VWF activity and FVIII levels and has similar PK properties to previously used concentrate. However, based on the results of this study prolonged PK assessment appears important in selected cases. Disclosures: Hegener: Octapharma AG: Employment. Austin:Baxter: Advisory Board Other; Pfizer: Advisory Board, Advisory Board Other.

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Is the Anterior Tibial Artery Safe During Ankle Arthroscopy?

The American Journal of Sports Medicine ◽

10.1177/0363546511416317 ◽

2011 ◽

Vol 39 (11) ◽

pp. 2452-2456 ◽

Cited By ~ 16

Author(s):

Kwang-Hyun Son ◽

Jae Ho Cho ◽

Jin Woo Lee ◽

Kyu-Sung Kwack ◽

Seung Hwan Han

Keyword(s):

High Risk ◽

Joint Capsule ◽

Ankle Arthroscopy ◽

Anterior Tibial Artery ◽

Increased Risk ◽

Anterior Tibial ◽

The Mean ◽

Type 3

Background: Pseudoaneurysm of the anterior tibial artery (ATA) after ankle arthroscopy is an uncommon complication but can cause unexpected consequences. However, its contributing factor is not fully understood. Hypothesis: Anatomic factors, such as ATA variations and the distance between the ATA and joint capsule, may contribute to the occurrence of pseudoaneurysm. Study Design: Case series; Level of evidence, 4. Methods: The magnetic resonance images and medical records of 358 ankle cases were analyzed. According to locations of the ATA in relation to the peroneus tertius (PT) and the extensor digitorum longus (EDL) tendon on axial magnetic resonance imaging, patients were classified as type 1 (safe type), type 2 (increased risk type), or type 3 (high-risk type). In addition, distances between the anterior joint capsule and the ATA were measured to evaluate the thickness of the anterior fat pad, which contains the ATA and anterior compartment tendons. Results: In 336 cases (93.8%), the ATA was located medial to the EDL (type 1, safe). In 7 cases (2.0%), the ATA was located lateral to the EDL and PT tendon (type 2, increased risk); and in 15 cases (4.2%), the branching artery was observed lateral to the EDL and PT tendon and the ATA was in the normal position (type 3, high risk). The mean distance between the anterior joint capsule and the ATA was 2.3 ± 1.1 mm. Conclusion: In 22 (6.2%) of the 358 cases, the ATA and its branches were located near the anterolateral ankle portal, which introduces the risk of vascular damage during arthroscopic surgery. Furthermore, the mean distance between the ATA and the joint capsule was only 2.3 ± 1.1 mm, and thus the ATA is very close to the anterior working space of the ankle joint. Careful preoperative evaluation and an intra-articular procedure may reduce the risk of vascular complications attributable to ankle arthroscopy.

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Effect of aging on the configurational change of the aortic arch

Geriatric Care ◽

10.4081/gc.2016.5720 ◽

2016 ◽

Vol 2 (1) ◽

Cited By ~ 2

Author(s):

Atsuhiro Kojima ◽

Isako Saga

Keyword(s):

Computed Tomography ◽

Aortic Arch ◽

Computed Tomography Angiography ◽

Smoking Habit ◽

Patient Characteristics ◽

The Mean ◽

Type 3 ◽

The Relationship

We explored the relationship between aging and the configuration of the aortic arch using computed tomography angiography (CTA). We retrospectively reviewed CTA obtained in 140 cases. The configuration of the aortic arch was categorized into three types based on the criteria mentioned by Madhwal <em>et al</em>., and the relationships between each configuration and patient characteristics were analyzed. Anomalies of the aortic arch were also explored. Twenty patients had a type-1 aortic arch (mean age, 56.1 years), 30 patients had a type-2 aortic arch (mean age, 66.3 years), and 89 patients had a type-3 aortic arch (mean age, 71.7 years). The mean age of patients with a type-3 aortic arch was significantly higher than that of patients with a type-1 aortic arch. No significant correlations between the type of aortic arch and other factors, such as smoking habit, were seen. The configuration of the aortic arch in our study appears to be significantly affected by the age of the patients.

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Computed Tomography Analysis of the Ethmoid Roof: A Region at Risk in Endoscopic Sinus Injury

The ASEAN Journal of Radiology ◽

10.46475/aseanjr.v19i2.28 ◽

2019 ◽

Vol 19 (2) ◽

pp. 108-115

Author(s):

Pra Urusopone

Keyword(s):

Computed Tomography ◽

Facial Bones ◽

Significant Difference ◽

The Mean ◽

Type 3 ◽

Tomography Analysis

Objective: To determine the olfactory fossa depth according to the Keros classification and determine the incidence of asymmetry in height and configuration of the ethmoid roof. Materials and Methods: Retrospective analysis of 75 coronal computed tomography studies of paranasal sinuses and facial bones were performed. Measurement of the depth of the lateral lamella, classification of the depth according to Keros type and determination of the asymmetries in the ethmoid roof depth and configuration were done. Results: The mean height of the lateral lamella cribiform plate (LLCP) was 2.15+1.29 mm. The cases were classified as 87.33% Keros type1 and 12.67 % as Keros type 2. No Keros type 3 was found .There was asymmetry in the LLCP height of 33.33% of cases and a configuration asymmetry in 8% of the cases. No significant difference between the mean height and distribution of Keros type between gender and laterality were also found. Conclusion: As regards the olfactory fossa depth, the Keros type 1 was most frequently found. Asymmetry in the depth and configuration were detected in 33.33 and 8% respectively. Risk of inadvertent intracranial entry through the lateral lamella among Thai may be lower than other studies with majority of cases classified as Keros type 2 or 3.

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Surgical results for hypertensive intracerebral hemorrhagesdepending on intervention timing

Annals of Clinical and Experimental Neurology ◽

10.54101/acen.2021.4.4 ◽

2021 ◽

Vol 15 (4) ◽

pp. 36-43

Author(s):

Vladimir G. Dashyan ◽

Ivan M. Godkov ◽

Leonid V. Prokop’ev ◽

Andrey A. Grin ◽

Vladimir V. Krylov

Keyword(s):

Disease Onset ◽

Haemorrhagic Stroke ◽

Total Sample ◽

Intracerebral Haematoma ◽

Intracranial Hemorrhages ◽

The Mean ◽

Type 3 ◽

Mean Time

Study aim. To analyse the surgical outcomes in patients with haemorrhagic stroke depending on the timing of surgery. Materials and methods. We performed a retrospective analysis of 500 patients (335 (67%) men and 165 (33%) women), who underwent surgical treatment of hypertensive intracranial hemorrhages at the N.V. Sklifosovsky Research Institute for Emergency Medicine between 1997 and 2020. The mean patient age was 53.1 12.2 years. The mean time until surgery was 3.3 2.6 days. Outcomes were assessed on day 30 from disease onset using the modified Rankin Scale (mRS). Results. In the total sample, outcomes as measured by the mRS were as follows: type 0 84 (16.8%) patients, type 1 37 (7.4%), type 2 46 (9.2%), type 3 38 (7.6%), type 4 43 (8.6%), type 5 142 (28.4%) and type 6 110 (22.0%). Treatment results were better when surgery was delayed (2 = 64.4; p 0.00001). Mortality was 36.4% after surgery conducted in the first day after haemorrhage, while mRS scores of 02 made up 18.6%. Mortality was 20.4% after surgery conducted on the second or third day, and mRS scores of 02 made up 29.6%. Mortality was 17.4% after surgery conducted on day 47, and mRS scores of 02 outcomes were present in 49.0% of subjects. Mortality was 8.8% when surgery was performed on day 8 or later, and favourable outcomes were present in 48.5% of patients. Conclusion. Intracerebral haematoma excision on day 23 leads to better outcomes in patients with reduced levels of alertness up to sopor, while surgery after day 3 leads to better results in alert patients and those with obtundation.

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Von Willebrand Disease (VWD) - A Disease with Dual Factor Deficiencies- Discrepant FVIII:C Pharmacokinetic (PK) Characteristics in a Head to Head Trial of Two VWF/FVIII Concentrates.

Blood ◽

10.1182/blood.v110.11.2141.2141 ◽

2007 ◽

Vol 110 (11) ◽

pp. 2141-2141

Author(s):

Craig M. Kessler ◽

Bruce A. Schwartz

Keyword(s):

High Purity ◽

Coagulation Factor ◽

Von Willebrand Disease ◽

Multiple Time ◽

Random Allocation ◽

Fviii Activity ◽

The Mean ◽

Type 3

Abstract Introduction: The PK profile of VWF/FVIII concentrate is very important in the treatment of individuals with VWD since this coagulopathy is a combined deficiency of qualitative and/or quantitative VWF functions specifically and of FVIII activity indirectly. A prospective randomized, crossover study was performed to investigate the PK properties of two VWF/FVIII concentrates (Wilate® and Humate-P®) in subjects with inherited VWD. This is the first head-to-head PK study performed within the same subject, comparing two plasma derived concentrates, one a new high purity VWF/FVIII product (Wilate) and an existing first generation intermediate purity concentrate (Humate-P). Methods: This prospective, randomized, controlled, open-labeled, 2-arm crossover, multi-center study included subjects with inherited and defined VWD, who underwent PK assessments after random allocation in Period 1 to a single 40 IU VWF:RCo /kg bolus dose of either Wilate or with Humate-P. After a washout period of at least 7 days, subjects received the other study VWD replacement concentrate for Period 2. During both study periods, plasma samples were tested at multiple time points for coagulation factor activities. The objective of the study was to evaluate the PK profiles of both, including the in-vivo terminal half-life (t1/2) of FVIII:C, VWF:RCo, VWF:Ag, and VWF:CB. Results: A total of 22 subjects with inherited VWD (Type 1, n=6; Type 2, n=9 [6 Type 2A, 1 Type 2B, and 2 Type 2M]; and Type 3, n=7) were randomized in the study. The VWF PK profiles for VWF after Wilate or Humate-P were similar with no appreciable difference in the mean t1/2 for VWF activities in Type 3 and Type 1 subjects (10 hrs for Humate-P and 12.6 hrs for Wilate using the VWF:RCo assay). For VWD Type 2 subjects the mean t1/2 was longer, but with no consistent differences between the concentrates. There were no significant differences in recovery, and consequently Cmax and AUC between Wilate and Humate-P. In patients receiving Wilate, there were almost parallel decay curves and t1/2 between VWF (RCo-12.6hr) and FVIII (FVIIIC -13hr) activity. In the analysis of FVIII:C PK profiles, Humate- P showed an unusually sustained FVIII:C decay curve plateau, which may represent the net combined effects of decreasing exogenous and increasing endogenous FVIII activities in the patient and the increased FVIII:C binding capacity of the excessive quantity of non-functional VWF:Ag present in this product. There was a significant discrepancy in the mean t1/2 for FVIII:C measured in VWD Type 3 subjects (35.7 hrs for Humate-P and 13 hrs for Wilate), using either one stage or chromogenic FVIII:C assays. Conclusions: This study confirms the similarity of the VWF PK properties of Wilate and Humate-P. However, this was not the case for FVIII activity, which revealed a significantly prolonged t1/2 versus the t1/2 of VWF:RCo for Humate-P measured in type 3 VWD patients after infusion. In contrast, following infusion of Wilate there was the initial expected FVIII:C peak followed by a parallel decay curves for both VWF:RCo and FVIII:C activities. This favorable PK profile for the new high purity VWF/FVIII concentrate, Wilate, should facilitate the dosing and laboratory monitoring of VWF replacement in VWD and should improve safety and efficacy by avoiding over or under dosing of each of the two critical coagulation parameters, especially in the situation of repeated dosing of the concentrates.

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SCARRED UTERUS;

The Professional Medical Journal ◽

10.29309/tpmj/2012.19.03.2117 ◽

2012 ◽

Vol 19 (03) ◽

pp. 304-307

Author(s):

SAIMA PERVEEN ◽

ALI ZUL HASNAIN

Keyword(s):

Post Partum ◽

Caesarean Section Rate ◽

Previous History ◽

Placenta Praevia ◽

History Of ◽

The Mean ◽

Scarred Uterus ◽

Type 3

Objective: To study frequency of Scarred Uterus in placenta praevia. Design: Descriptive observational study. Place andDuration Of Study: December 2008-December 2009 Holy family Hospital Rawalpindi. Patients and Methods: 50 patients with placentapraevia presented to Holy Family Hospital Gynae and Obs unit II during this period. All patients either admitted through emergency or Gynaeoutpatient department were included. Results: The mean age of patients with placenta Praevia was 29.04 year with (SD =5.11).The meangestational age was 34.6 weeks and (SD = 2.7). Fourteen (28%) patients were gravida 2 and 13(26%) were primigravida. Fifteen (30%) patientswere para 1 & 14 (28%) were para 0. Painless vaginal bleeding was the presenting complaint in 38(76%) patients, whereas 12(24%) patientswere diagnosed on routine ultrasonography. Nine (18%) cases underwent spontanouse vertex delivery and 41 (82%) cases were delivered bycaesarean section. Placenta Praevia type 1 in 7 (14%) cases. Placenta Praevia type 2 in 20 (40%) cases, type 3 in 14 (28%) cases, type 4 in 9(18%) cases . Previous history of scarred uterus was found in 16 (32%) cases .Post partum haemorrhage occurred in 13 (26%) cases.caesarean hysterectomy in 5 (10%) cases. Conclusions: A scarred uterus leads to increase frequency of Placenta Praevia, scarring of uteruscan be reduced by keeping the caesarean section rate within reasonable limits and instead of doing surgical evacuation of retained products ofconception, suction and evacuation by suction canula.

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