PATIENTS AND METHODS: The institutional review board approved this prospective study. The brain MRI protocol, including sagittal T1-weighted, axial T2-weighted, coronal fluid-attenuated inversion recovery, and axial T1-weighted with contrast enhancement (T1WCE) sequences, was assessed in 26 patients divided into two groups: Medulloblastoma (n=22) and ependymoma (n=4). The quantified region of interest (ROI) values of tumors and their ratios to parenchyma were compared between the two groups. Multivariate logistic regression analysis was utilized to find significant factors influencing the differential diagnosis between the two groups. A generalized estimating equation (GEE) was used to create the predictive model for the discrimination of medulloblastoma from ependymoma.
RESULTS: Multivariate logistic regression analysis showed that the T2- and T1WCE-ROI values of tumors and the ratios of T1WCE-ROI values to parenchyma were the most significant factors influencing the diagnosis between these two groups. GEE produced the model: y=exn/(1+exn) with predictor xn=-8.773+0.012x1 - 0.032x2 - 13.228x3, where x1 was the T2-weighted signal intensity (SI) of tumor, x2 the T1WCE SI of tumor, and x3 the T1WCE SI ratio of tumor to parenchyma. The sensitivity, specificity, and area under the curve of the GEE model were 77.3%, 100%, and 92%, respectively.
CONCLUSION: The GEE predictive model can discriminate between medulloblastoma and ependymoma clinically. Further research should be performed to validate these findings.
PRESENTATION OF CASE: A 39-day-old infant presented with progressive right maxillary swelling complicated by methicillin-resistant Staphylococcus aureus orbital abscess. Tooth bud abscess was the most likely primary cause and a combination of intravenous antibiotics was initially prescribed. The collection of intra-orbital pus was removed using image-guided system-aided endoscopic surgical drainage.
DISCUSSION: Prompt diagnosis and management are very crucial. Endoscopic drainage of these abscesses in children has been described. Image-guided drainage of the orbital abscess is a newer technique that has been reported in a teenager and in adult patients. This is the first reported case of endoscopic orbital drainage surgery in an infant. The procedure was performed successfully. This approach provides for better identification of the anatomical structures in a very young patient. Injuries to the medial rectus, globe and optic nerve can be avoided with this technique.
CONCLUSION: Aggressive management of orbital abscesses in infants is mandatory. Image-guided endoscopic orbital drainage offers precise visualization and a safer technique in a relatively smaller orbit.
CASE PRESENTATION: In this article, we report the case of a 24-year-old woman at 32 weeks' gestation who presented with hypoxemic respiratory failure requiring mechanical ventilation. She was successfully managed by NIV.
DISCUSSION: However, NIV must be managed by providers who are trained in mechanical ventilation. This is of the utmost importance in avoiding any delay should the patient's condition worsen and require endotracheal intubation. Moreover, in pregnant women, the severity of illness may progress quickly due to the immunosuppression inherent in these patients.
CONCLUSION: Special attention should be given to the choices of invasive ventilation and NIV to manage community acquired pneumonia patients in third trimester.
METHOD: This pilot study screened 60 patients who underwent ultrasound-guided supradiaphragmatic central venous catheter insertion. We compared the investigators' guidewire's J-tip detection, D50% rapid atrial swirl sign (RASS) findings on the RVI-PLAX view and the central venous catheter tip on chest radiograph. We also compared the mean capillary blood sugar level before and after the 5 ml D50% flush.
RESULTS: No guidewire J-tips were detected from the RVI-PLAX view. The first and second investigators' diagnosis of central venous catheter malposition detected on RVI-PLAX CEUS achieved an almost perfect agreement (κ = 1.0 (95% confidence interval (CI): 0.90 to 1.0), p
METHODS: This study included 33 women who underwent HIFU treatment. Tissue characteristics of leiomyomas were assessed based on T2- and T1-weighted MRI. The immediate nonperfused volume (NPV) ratio and the treatment effectiveness of MRI-guided HIFU on the basis of the degrees of volume reduction and improvement in transformed symptom severity score (SSS) were assessed.
RESULTS: The median immediate NPV ratio was 89.8%. Additionally, the median acoustic sonication power and HIFU treatment durations were 150 W and 125 min, respectively. At six-month follow-up, the median leiomyoma volume had decreased from 139 mL at baseline to 84 mL and the median transformed SSS had decreased from 56.2 at baseline to 18.8. No major adverse events were observed.
CONCLUSION: The preliminary results demonstrated that volumetric MRI-guided HIFU therapy for the treatment of symptomatic leiomyomas in ASEAN patients appears to be clinically acceptable with regard to treatment effectiveness and safety.
Discussion: The scenario is made worst if the aspiration causes acute hypoxemic respiratory failure immediately post intubation. However, in the event of desaturation, the quick decision to proceed with bronchoscopy is a challenging task to the anesthesiologist without knowing the causes.
Case presentation: We present a case of a 12-year-old boy who had a difficult-to-ventilate scenario post transferring and immediately connected to ventilator in operation theatre (OT) from portable ventilator from the emergency department. She was successfully managed by bronchoscopy.
Conclusion: Special attention should be given to the difficult-to-ventilate scenario post intubation of traumatic brain injury patient prior to operation. Prompt diagnosis and bronchoscope-assisted removal of foreign body was found to be a successful to reduce morbidity and mortality.