We report a case of an adult who presented with progressive swelling in the right eye with suggestive of intracranial lesion on imaging. Histopathological revealed a lacrimal gland malignant mixed tumour.
The analysis of the skin mechanical behaviour is a key-point for different field of investigation. As the skin is a complex structure, studies are usually based on inverse methods that compare experimental and finite element numerical results. Besides the considered behaviour law, one of the most important question concerns the geometrical aspects of the skin tissue. In this paper, it is shown how high frequency ultrasound imaging helps the calculation of skin mechanical parameters. The hypodermis influence is firstly discussed through elastographic analyses. A specific procedure to measure the dermis thickness is then proposed to highlight that such a measurement must be considered to draw reliable conclusions. The obtained results are finally discussed to point out the interest of such simplifications for the study of more complex behaviour laws.
Craniopharyngioma cyst enlargement after surgery and radiation therapy is often presumed to represent a treatment failure, instigating further management strategies. We present an eight-year-old girl with a small intrasellar residuum post-resection who then developed cystic enlargement post-radiotherapy. With close surveillance, the cyst spontaneously resolved.
Aim: This study was designed to evaluate the use of ultrasound in diagnosis of infection and tumour of long bones.Methodology: Patients referred from the orthopaedic unit with doubt regarding long bone clinical and/or radiological signs which could be tumour or infection were enrolled in this study.Analysis of ultrasound characteristics included presence of pericortical fluid over normal cortex well away from the primary lesion, wavy contour sign (fluid tracking in and out muscle planes), subperiosteal fluid and soft tissue mass displacing adjacent muscle planes.Results: Fourteen out of 15 patients with confirmed osteomyelitis were diagnosed by ultrasound examination.Ultrasound as a diagnostic tool has a sensitivity of 93% and specificity of 100%.The most accurate indicator was pericortical fluid noted up to several centimetres from the long bone abnormality seen on plain x-rays. Conclusion:Ultrasound is a safe, fast, cost-effective imaging modality that can play an important role in diagnosis of osteomyelitis as it then serves as a tool for ultrasound guided aspiration.
Background/purpose: Optical coherence tomography (OCT) is an imaging system that enables in vivo epidermal thickness (ET) measurement. In order to use OCT in large‐scale clinical studies, automatic algorithm detection of the dermo‐epidermal junction (DEJ) is needed. This may be difficult due to image noise from optical speckle, which requires specific image treatment procedures to reduce this. In the present work, a description of the position of the DEJ is given, and an algorithm for boundary detection is presented. Methods: Twenty‐nine images were taken from the skin of normal healthy subjects, from five different body sites. Seven expert assessors were asked to trace the DEJ for ET measurement on each of the images. The variability between experts was compared with a new image processing method. Results: Between‐expert variability was relatively low with a mean standard deviation of 3.4 μm. However, local positioning of the DEJ between experts was often different. The described algorithm performed adequately on all images. ET was automatically measured with a precision of <5 μm compared with the experts on all sites studied except that of the back. Moreover, the local algorithm positioning was verified. Conclusion: The new image processing method for measuring ET from OCT images significantly reduces calculation time for this parameter, and avoids user intervention. The main advantages of this are that data can be analyzed more rapidly and reproducibly in clinical trials.
Introduction Unruptured intracranial aneurysms (UIA) are common in the adult population, but only a relatively small proportion will rupture. It is therefore essential to have accurate estimates of rupture risk to target treatment towards those who stand to benefit and avoid exposing patients to the risks of unnecessary treatment. The best available UIA natural history data are the PHASES study. However, this has never been validated and given the known heterogeneity in the populations, methods and biases of the constituent studies, there is a need to do so. There are also many potential predictors not considered in PHASES that require evaluation, and the estimated rupture risk is largely based on short-term follow-up (mostly 1 year). The aims of this study are to: (1) test the accuracy of PHASES in a UK population, (2) evaluate additional predictors of rupture and (3) assess long-term UIA rupture rates. Methods and analysis The Risk of Aneurysm Rupture study is a longitudinal multicentre study that will identify patients with known UIA seen in neurosurgery units. Patients will have baseline demographics and aneurysm characteristics collected by their neurosurgery unit and then a single aggregated national cohort will be linked to databases of hospital admissions and deaths to identify all patients who may have subsequently suffered a subarachnoid haemorrhage. All matched admissions and deaths will be checked against medical records to confirm the diagnosis of aneurysmal subarachnoid haemorrhage. The target sample size is 20 000 patients. The primary outcome will be aneurysm rupture resulting in hospital admission or death. Cox regression models will be built to test each of the study’s aims. Ethics and dissemination Ethical approval has been given by South Central Hampshire A Research Ethics Committee (21SC0064) and Confidentiality Advisory Group support (21CAG0033) provided under Section 251 of the NHS Act 2006. The results will be disseminated in peer-reviewed journals. Trial registration number ISRCTN17658526 .
Sir,ARUBA (A Randomised trial of Unruptured Brain AVMs) trial published by Mohr et al.1 showed that medical management alone was superior to interventional therapy for the prevention of death or st...
Abstract: Reflectance confocal microscopy (RCM) may help to quantify variations of skin pigmentation induced by different stimuli such as UV radiation or therapeutic intervention. The objective of our work was to identify RCM parameters able to quantify in vivo dermis papilla density and epidermis pigmentation potentially applicable in clinical studies. The study included 111 healthy female volunteers with phototypes I–VI. Photo‐exposed and photo‐protected anatomical sites were imaged. The effect of age was also assessed. Four epidermis components were specifically investigated: stratum corneum, stratum spinosum, basal epidermal layer and dermo‐epidermal junction. Laser power, diameter of corneocytes and upper spinous keratinocytes, brightness of upper spinous and interpapillary spinous keratinocytes, number of dermal papillae and papillary contrast were systematically assessed. Papillary contrast measured at the dermo‐epidermal junction appeared to be a reliable marker of epidermis pigmentation and showed a strong correlation with skin pigmentation assessed clinically using the Fitzpatrick’s classification. Brightness of upper spinous and interpapillary spinous keratinocytes was not influenced by the skin phototype. The number of dermal papillae was significantly lower in subjects with phototypes I–II as compared with darker skin subjects. A dramatic reduction in the number of dermal papillae was noticed with age, particularly in subjects with fair skin. The method presented here provides a new in vivo investigation tool for quantification of dermis papilla density and epidermal pigmentation. Papillary contrast measured at the dermo‐epidermal junction may be selected as a marker of skin pigmentation for evaluation in clinical studies.
Background Glioblastoma (GBM) is the most common malignant primary brain tumour and confers a very poor prognosis. Maximal safe resection of tumour is the goal of neurosurgical intervention and may be more easily achieved through the use of surgical adjuncts such as fluorescence-guided surgery (FGS). 5-Aminolevulinic acid (5-ALA) accumulates in GBM tissue and fluoresce red, distinguishing tumour cells from the surrounding tissue and therefore making resection easier. 5-ALA-guided resection in GBM has been shown to increase resection rates and prolong progression-free survival without impacting post-operative morbidity. Radiotherapy and concomitant chemotherapy also improve survival in GBM. Other factors such as patient age and molecular status of the tumour also impact prognosis. Aims The aim of this study was to compare the outcomes of 5-ALA vs white light-guided resection for glioblastoma in the west of Scotland. Methods This was a retrospective analysis of baseline characteristics (age, sex, tumour molecular markers, radiotherapy, chemotherapy, anatomical location of tumour and treatment group) and outcomes (mortality, survival, degree of resection and performance status) of 239 patients who underwent primary resection of glioblastoma over a four-year period (2017-2020). A variety of statistical methods were used to analyse the relationship between each variable and surgical technique; multivariate Cox regression and the Kaplan-Meier method were used in survival analysis. Results 5-ALA-guided resection substantially improved resection rates (74.0% vs 40.2%). Mortality at 15 months was 5.1% lower in the 5-ALA group (52.0% vs 57.1%, p = 0.53), and patients lived an average of 68 days longer compared to the white light group (444 days vs 376 days, p = 0.21). There were negligible differences between treatment groups in terms of post-operative performance status (PS) and post-operative complications. In our multivariate Cox regression model, six factors were statistically significant at a level of p ≤ 0.05: age, radiotherapy, chemotherapy, O(6)-methylguanine-DNA methyltransferase (MGMT) methylation, anatomical location and >90% resection. Receiving chemotherapy and radiotherapy, MGMT methylation and undergoing >90% resection conferred a survival benefit at 15 months. Older age and multi-focal disease were related to a worsened mortality rate. Undergoing radiotherapy and maximal resection were the two greatest predictors of improved survival, reducing mortality risk by 58% and 51%, respectively. Conclusion 5-ALA-guided resection improved resection rates without impacting post-operative morbidity. 5-ALA-guided resection was associated with improved survival and lower mortality rate, but this was not statistically significant. Receiving chemoradiotherapy, MGMT methylation and undergoing maximal resection conferred a survival benefit, whilst older age and multi-focal disease were associated with a poorer prognosis.
The analysis of the skin mechanical behaviour is a key-point for different field of investigation. As the skin is a complex structure, studies are usually based on inverse methods that compare experimental and finite element numerical results. Besides the considered behaviour law, one of the most important question concerns the geometrical aspects of the skin tissue. In this paper, it is shown how high frequency ultrasound imaging helps the calculation of skin mechanical parameters. The hypodermis influence is firstly discussed through elastographic analyses. A specific procedure to measure the dermis thickness is then proposed to highlight that such a measurement must be considered to draw reliable conclusions. The obtained results are finally discussed to point out the interest of such simplifications for the study of more complex behaviour laws.
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