Zobrazení zdroje stránky Krogsgaardlawson3426

PURPOSE Age and etiology play a crucial role in success of endoscopic third ventriculostomy (ETV) as a treatment of obstructive hydrocephalus. Outcome is worse in infants, and controversies still exist whether ETV is superior to shunt placement. We retrospectively analyzed 70 patients below 2&nbsp;years from 4 different centers treated with ETV and assessed success. METHODS Children less then  2&nbsp;years who received an ETV within 1994-2018 were included. Patients were classified according to age and etiology; less then  3, 4-12, and 13-24&nbsp;months, etiologically; aqueductal stenosis, post-hemorrhagic-hydrocephalus (PHH), tumor-related, fourth ventricle outflow obstruction, with Chiari-type II and following CSF infection. We investigated statistically the predictors for ETV success through computing Kaplan-Meier estimates using patient's follow-up time and time to ETV failure. RESULTS We collected 70 patients. ETV success rate was 41.4%. The highest rate was in tumor-related hydrocephalus and fourth ventricle outlet obstruction (62.5%, 60%) and the lowest rate was in Chiari-type II and following infection (16.7%, 0%). The below 3&nbsp;months age group showed relatively lower success rate (33.3%) in comparison to older groups which showed similar results (46.4%, 46.6%). Statistically, a previous VP shunt was a predictor for failure (p value less then  0.05). CONCLUSION Factors suggesting a high possibility of failure were age less then  3&nbsp;months and etiology such as Chiari-type II or following infection. Altered CSF dynamics in patients with PHH and under-developed arachnoid villi may play a role in ETV failure. We do not recommend ETV as first line in children less then  3&nbsp;months of age or in case of Chiari II or following infection.PURPOSE There is no consensus in the literature about the impact of hydrocephalus on clinical course and overall survival of diffuse intrinsic pontine gliomas (DIPG) patients as well as about its specific treatment. Authors reviewed a series of DIPG patients to investigate factors related to the onset of hydrocephalus, its treatment, and its impact on clinical course and prognosis. METHODS A retrospective observational study was performed enrolling pediatric patients affected by DIPG from 2008 to 2018. Clinical and radiological charts were reviewed to find patients' demographic, pathologic and radiologic features in hydrocephalic and non-hydrocephalic patients. In the hydrocephalus cohort, treatment strategy and its effectiveness and complications were analyzed. RESULTS Ninety-four pediatric patients were enrolled in the study. Patients who developed hydrocephalus showed significantly lesser maximum axial tumor areas than patients without hydrocephalus (respectively 6.5&nbsp;cm2 vs 16.45&nbsp;cm2, p&nbsp; less then  0.005). [https://www.selleckchem.com/products/mivebresib-abbv-075.html ABBV-075 mw] Hydrocephalus developed in 33 patients (35%) with an onset interval of 5.24 ± 1.21&nbsp;months (range 3.2-7.3). The majority of hydrocephalic patients (28 cases, 90%) were treated by ventriculoperitoneal shunt, the remaining 3 patients being treated by endoscopic third ventriculostomy. Mean overall survival was 16.6&nbsp;months ± 20&nbsp;months without significative difference between the groups. CONCLUSION The onset of hydrocephalus occurs in the first moths of the disease story and found a negative correlation with tumor maximal axial diameter. Early treatment of hydrocephalus presents a very low complications rate with satisfying clinical outcome, as it allows the patients to continue the neurooncological therapies being a part of the treatment armamentarium instead of a palliative solution.OBJECTIVES To summarise and compare the performance of magnification mammography and digital zoom utilising a full-field digital mammography (FFDM) system in the detection and diagnosis of microcalcifications. METHODS We ran an extended search in MEDLINE, EMBASE, CINAHL, Engineering Village and Web of Science. Diagnostic test studies, experimental breast phantom studies and a Monte Carlo phantom study were included. A narrative approach was selected to summarise and compare findings regarding the detection of microcalcifications, while a hierarchical model with bivariate analysis was used for the meta-analysis of sensitivity and specificity for diagnosing microcalcifications. RESULTS Nine studies were included. Phantom studies suggested that the size of microcalcifications, magnification or zoom factor, exposure factors and detector technology determine whether digital zoom is equivalent to magnification mammography in the detection of microcalcifications. Pooled sensitivity for magnification and zoom calculated from the diagnostic test studies was 0.93 (95% CI 0.84-0.97) and 0.85 (95% CI 0.70-0.94), respectively. Pooled specificity was 0.55 (95% CI 0.51-0.58) and 0.56 (95% CI 0.50-0.62), respectively. The differences between the sensitivities and specificities were not statistically significant. CONCLUSIONS Digital zoom may be equivalent to magnification mammography. Diagnostic test studies and phantom studies using newer detector technology would contribute additional knowledge on this topic. KEY POINTS • The performance of digital zoom is comparable to magnification for detecting microcalcifications when newer detector technology and optimised imaging procedures are utilised. • The accuracy of digital zoom appears equivalent to geometric magnification in diagnosing microcalcifications.OBJECTIVES This systematic review and meta-analysis aimed to evaluate the current evidence on the diagnostic accuracy of the Ottawa Knee Rule (OKR) for acute knee injuries in adults. METHODS A literature search of Embase (Elsevier), MEDLINE (U.S. National Library of Medicine), PubMed and Scopus databases (1995 to date; English language) was performed and the relevant references were assessed. Original articles documenting OKR use by emergency physicians to assess adult acute knee injuries were included. Study methodological quality was assessed using the Quality Assessment of Diagnostic Accuracy Studies 2 (QUADAS-2) tool. Results of eligible studies were pooled using random effects or fixed effects modelling to calculate the diagnostic performance of the OKR. The Higgins I2 test and Begg's association test were performed to assess between-study heterogeneity and publication bias respectively, with Spearman's correlation test for threshold effect. RESULTS Eight studies, including 7385 patients, were enrolled and pooled using the random effects model.