A Case of Small Bowel Intimation with Sepsis

Introduction: Sepsis is a life-threatening organ failure that occurs in severely ill patients as a result of a primary infectious cause or subsequent infection of injured tissues. The systemic effects of sepsis have been extensively studied, and evidence of local alterations and repercussions in the intestinal mucosal compartment is gradually characterizing sepsis-related changes in the gut. The current study focuses on sepsis-induced intestinal barrier failure, which includes increased epithelial permeability, which may allow bacterial translocation. The small bowel, commonly known as the small intestine, is roughly 1 inch in diameter and 20 to 30 feet long. It has a lot of folds to help it fit inside the abdominal cavity. The small bowel is connected to the stomach on one end and the big intestine on the other. Patient information: He was 63 years old male admitted to Acharya Vinoba Bhave Rural hospital sawangi meghe Wardha in MICU ward with chief complaints of altering sensorium. Low urine output vomiting, loss of appetite, swelling of the abdomen crampy abdominal pain that comes and goes. The Main Diagnosis, Therapeutic Intervention and Outcomes: A CT scan revealed a thicker transverse colon wall. His flexible sigmoidoscopy revealed “patchy inflammation and an isolated area of severe deep ulceration with nodularity and edema,” according to the report. The patient was given a preliminary diagnosis of "Inflammatory Bowel Disease—likely Crohn's," and was treated with steroids and Patient was done colonoscopy and course of inj. hydrocortisone, inj. Neomol, inj. levipril. Conclusion: In the case of acute small-bowel obstruction, helical CT is a highly sensitive approach for diagnosing or ruling out intestinal ischemia. In patients with significant trauma who are being assessed for sepsis of unknown origin, abdominal computed tomographic scans accurately identify intra-abdominal foci of infection. This patient was diagnosed with small bowel intimation and sepsis.

Radiopaque drug-eluting embolisation beads as fiducial markers for stereotactic liver radiotherapy

Objective: To determine the feasibility of using radiopaque (RO) beads as direct tumour surrogates for image-guided radiotherapy (IGRT) in patients with liver tumours after transarterial chemoembolisation (TACE). Methods: A novel vandetanib-eluting RO bead was delivered via TACE as part of a first-in-human clinical trial in patients with either hepatocellular carcinoma or liver metastases from colorectal cancer. Following TACE, patients underwent simulated radiotherapy imaging with 4-dimensional computed tomography (4D-CT) and cone-beam CT (CBCT) imaging. RO beads were contoured using automated thresholding, and feasibility of matching between the simulated radiotherapy planning dataset (AVE-IP image from 4D data) and CBCT scans assessed. Additional kV, MV, helical CT and CBCT images of RO beads were obtained using an in-house phantom. Stability of RO bead position was assessed by comparing 4D-CT imaging to CT scans taken 6–20 days following TACE. Results: Eight patients were treated and 4D-CT and CBCT images acquired. RO beads were visible on 4D-CT and CBCT images in all cases and matching successfully performed. Differences in centre of mass of RO beads between CBCT and simulated radiotherapy planning scans (AVE-IP dataset) were: 2.0 mm mediolaterally, 1.7 mm anteroposteriorally, 3.5 mm craniocaudally. RO beads in the phantom were visible on all imaging modalities assessed. RO bead position remained stable up to 29 days post-TACE. Conclusion: RO beads are visible on IGRT imaging modalities, showing minimal artefact. They can be used for on-set matching with CBCT and remain stable over time. Advances in knowledge: The role of RO beads as fiducial markers for stereotactic liver radiotherapy is feasible and warrants further exploration as a combination therapy approach.

Radiation dosimetry effect evaluation of a carbon fiber couch on novel uRT-linac 506c accelerator

Recently, a diagnostic helical CT is integrated into a linear accelerator, called uRT-linac 506c, whose CT scanning dataset can be directly used to do simulation. This novel structure provides a possibility for online adaptive radiotherapy. For adaptive radiotherapy, the carbon fiber couch is an essential external device for supporting and positioning patients. And the effect on dose attenuation and distribution caused by a couch is inevitable and vital for precise treatment. In this research, the couch equipped with uRT-linac 506c was evaluated on the radiation dosimetry effect. The treatment couch equipped on the uRT-linac 506c accelerator was evaluated, and its effect on the attenuation, surface dose and dose buildup were measured for different phantom positions (offset = 0 cm, offset = + 10 cm and offset = − 10 cm, respectively) and different gantry angles. Since uRT-linac 506c is exclusively capable to provide diagnostic CT scanning data with real relative electron density (RED), this CT scanning data of the couch can be used directly in uRT-TPS to design plans. This scanned couch dataset was designated as the model A. The model B was a dummy structure of a treatment couch inserted with artificially preset RED. The dose calculation accuracy of these two models was compared using PB, CC, and MC on uRT-TPS. With the effect of carbon fiber couch, the surface dose was increased at least 97.94% for 25 × 25 cm2 field and 188.83% for 10 × 10 cm2 field, compared with those without. At different phantom positions (offset = 0, + 10, − 10 cm), the attenuation for 6 MV photon beam at gantry angle 180° were 4.4%, 4.4%, and 4.3%, respectively, and varied with changes of gantry angle. There do exists dose deviation between measurement and TPS calculation with the involvement of treatment couch, among the three algorithms, MC presented the least deviation, and the model A made less and steadier deviation than the model B, showing promising superiority. The attenuation, surface dose, and buildup effects of the carbon fiber couch in this study were measured similarly to most counterparts. The dose deviation calculated based on the couch dataset scanned by the diagnostic helical CT was smaller than those based on a dummy couch. This result suggests that an accelerator equipped with a diagnostic CT, which can help reduce the dose deviation of the carbon fiber couch, is a promising platform for online adaptive radiotherapy.

Aortic dissection diagnosed on stroke computed tomography protocol: a case report

Background Aortic dissection is one of the causes of stroke. Because cerebral infarction with aortic dissection is a contraindication to intravenous recombinant tissue plasminogen activator (rt-PA) therapy, exclusion of aortic dissection is necessary prior to its administration. However, imaging takes time to provide a diagnosis, possibly causing delays in surgical treatment. Case presentation A 65-year-old Japanese female patient was transported to the hospital for a suspected stroke, with back pain and left upper and lower extremity palsy which occurred while eating. Upon arrival at the hospital, the left lower limb paralysis had improved, but the left upper limb paralysis remained. Right back pain had also developed. A plain head computed tomography (CT) scan performed 110 minutes after onset showed no acute bleeding or infarction. Subsequent CT perfusion (CTP) showed acute perfusion disturbance in the right hemisphere without infarction, known as ischemic penumbra. The four-dimensional maximum-intensity projection image reconstructed from CTP showed a delayed enhancement at the right internal carotid and right middle cerebral arteries compared to the contralateral side, suggesting a proximal vascular lesion. Contrast helical CT from the neck to abdomen revealed an acute aortic dissection of Stanford type A with false lumen patency. The dissection extended to the proximal right common carotid artery. The patient underwent an emergency total arch replacement and open stent graft. After recovering well, the patient was ambulatory upon discharge from the hospital. The combination of plain head CT, CTP, and helical CT scan from the neck to abdomen enabled us to evaluate for stroke and aortic dissection within a short amount of time, allowing for early therapeutic intervention. Conclusions When acute stroke is suspected due to neurological deficits, plain head CT is the first choice for imaging diagnosis. The addition of cervical CT angiography can reliably exclude stroke due to aortic dissection. CTP can identify ischemic penumbra, which cannot be diagnosed by plain head CT or diffusion-weighted magnetic resonance imaging. These combined stroke CT protocols helped us avoid missing an aortic dissection.

Cranial Structure of Varanus komodoensis as Revealed by Computed-Tomographic Imaging

This study aimed to describe the anatomic features of the normal head of the Komodo dragon (Varanus komodoensis) identified by computed tomography. CT images were obtained in two dragons using a helical CT scanner. All sections were displayed with a bone and soft tissue windows setting. Head reconstructed, and maximum intensity projection images were obtained to enhance bony structures. After CT imaging, the images were compared with other studies and reptile anatomy textbooks to facilitate the interpretation of the CT images. Anatomic details of the head of the Komodo dragon were identified according to the CT density characteristics of the different organic tissues. This information is intended to be a useful initial anatomic reference in interpreting clinical CT imaging studies of the head and associated structures in live Komodo dragons.

Morphometric analysis of foramen magnum using helical computed tomogrophy for gender determination

Background: The morphometric analysis of foramen magnum (FM) plays a crucial role in forensics and paleontology in identifying the gender of the unknown skeletal fragments. However, the reliability of these parameters vary among populations and races. The present study was conducted to investigate the reliability of the four foramen magnum parameters ie, foramen magnum transverse diameter, foramen magnum sagittal diameter, foramen magnum area and foramen magnum circumference in this native population. Methods: A total of 60 subjects belonging to both genders aged between 20 – 50 years who were undergoing computed tomography (CT) examination of head and neck region were selected for the study. The study sample comprised of 30 males in group A and 30 females in group B. The measurements were obtained from reformatted axial sections using helical CT scan. The FM sagittal diameter (FMSD) and the FM transverse diameter (FMTD) were measured by the greatest anteroposterior dimension and the greatest width of the foramen. The circumference (FMC) and the area (FMA) were obtained after tracing the bony margin of the FM on the CT image using CT workstation. Results: Mean values of all four parameters were found to be significantly higher in males compared to female subjects (P <0.001). Further, the accuracy of sex determination analyzed using the discriminant equation was 70% for males and 80% for females with overall accuracy of 75%. The predictability of gender was higher in female subjects than in male subjects. Conclusion: The dimensions of the foramen magnum can be used in gender determination of skeletal fragments with considerable accuracy. The Helical CT scan plays a pivotal role in providing accurate dimensions of the foramen magnum that could be useful in forensic testing.