Rio Grande Hospital is a critical access hospital in Del Norte, Colorado, in Rio Grande County. The hospital has 17 beds. In addition to the main hospital buildings in Del Norte, the hospital also operates clinics in Creede, South Fork, and Monte Vista. The hospital is a Level IV trauma center.
Background:Certain anatomical variants of the paranasal sinuses (PNS) predispose to injury of surrounding critical structures during functional endoscopic sinus surgery (FESS) and the occurrence of common pathologies like sinusitis. However, they are often not reported in preoperative computed tomography (CT). Methods:The CT scan of PNS and head of 360 adults (age > 13 years) were retrospectively evaluated for variants of cribriform plate, olfactory fossa, lamina papyracea, uncinate process, sphenoid pneumatization, and anterior ethmoid artery by 4 radiologists with experience of 3 to 6 years. The prevalence of each variant was obtained. Chi-squared and independent sample t-tests were used to analyze relationships between variables, with significance set at P < .05. Results:The prevalence of Keros Type 1, Type 2, and Type 3 olfactory fossa was 24.4%, 66.9%, and 8.6%, respectively, in the right side and 20.6%, 69.2%, and 10.3%, respectively, in the left side. Mean depth of right and left olfactory fossa was 4.9 mm (+/- 1.9) and 5.2 mm (+/- 1.8), respectively. Dehiscence/remote fracture of anterior skull base was observed in 1.9% cases. Dehiscence/remote fracture of lamina papyracea was present in 2.8% cases. Haller cells were observed in 13.9%. Conchal, presellar, incomplete sellar, and complete sellar pattern of pneumatization of sphenoid sinus had prevalences of 2.5%, 6.4%, 26.7%, and 64.4%, respectively. The prevalence of dehiscence of carotid canal in sphenoid sinus was 7.2%. The prevalence of bony septa insertion into carotid canal was 37.8%. The prevalence of supraorbital pneumatization was 51.4%. The prevalence of agger nasi cell and pneumatization of crista galli were 82.2% and 16.7%, respectively. Conclusion:Preoperative CT provides an opportunity to look for critical structures in relation to the PNS. Radiologists should report these findings to prevent potential complications during FESS.
Abstract Background: While several studies from high-income countries have evaluated hematopoietic cell transplantation (HCT) using haploidentical related (Haplo) and HLA-matched unrelated donors (MUD), prospective data from low- and middle-income countries remain scarce. Brazil, home to one of the world's largest unrelated donor registries, provides a unique setting to evaluate real-world HCT outcomes using Haplo and MUD. This study aimed to describe major HCT outcomes in adult patients with acute leukemia in complete remission (CR1 or CR2+), using data collected and curated in collaboration with the Center for International Blood and Marrow Transplant Research (CIBMTR). Methods: This multicenter prospective non-randomized observational study included 501 consecutive patients submitted to HCT from either a Haplo donor or MUD at 21 Brazilian centers between 2018 and 2021 and with data reported to the CIBMTR. Eligible patients were aged ≥18 years, diagnosed with acute myeloid leukemia (AML) or acute lymphoblastic leukemia (ALL), and in CR1 or CR2+ at the time of transplant. The primary outcomes were overall survival (OS) and relapse-free survival (RFS). Secondary endpoints included GVHD-free, relapse-free survival (GRFS), relapse incidence, non-relapse mortality (NRM), and acute/chronic graft-versus-host disease (GVHD). Univariable analyses used Kaplan-Meier and cumulative incidence methods. Multivariable Cox proportional hazards and competing risk models were adjusted for age, disease type and status, graft source, conditioning intensity, donor-recipient cytomegalovirus (CMV) status, and time from diagnosis to transplant. Results: Of the 501 HCT patients, 335 (66.8%) received a Haplo and 166 (33.2%) received a MUD transplant. The median follow-up was 26 months. Baseline characteristics differed between these two groups, including the proportion of CMV-negative donors (43 vs. 34%; p<0.001), the use of bone marrow grafts (54 vs. 39%; p<0.001), and the type of conditioning regimen (myeloablative in 84 vs. 76%; p<0.001), all of which were more common in the MUD group. Time from diagnosis to HCT was considerably longer for MUD recipients, especially in CR1 patients (9 vs. 7 months; p<0.001). Post-transplant cyclophosphamide (PTCy) was used in 92% of Haplo recipients and in 5% of MUD recipients, while antithymocyte globulin (ATG) was used in 91% of MUD and only 1% of Haplo transplants. At 2 years, OS was 61% (Haplo) vs. 66% (MUD; p=0.071), and RFS was 57% vs. 62% (p=0.19). GRFS was 44% (Haplo) vs. 47% (MUD; p=0.49), and NRM was 23% vs. 24% (p=0.96). The 2 -year relapse incidence was 20% for Haplo and 14% for MUD HCT (p=0.069). After adjusting for time to transplant, donor type was not an independent predictor of relapse (HR 1.53; 95% CI, 0.92–2.56; p=0.10). The incidence of grade III–IV aGVHD was 9% vs. 13% (p=0.17), and chronic GVHD was 15% vs. 16% (p=0.85) for Haplo and MUD transplants, respectively. In multivariable models, donor type was not independently associated with OS, RFS, GRFS, relapse, NRM, or GVHD outcomes. Conclusion: We found no difference in OS, RFS, GRFS, GVHD and NRM between Haplo and MUD transplants for patients with acute leukemias in complete remission undergoing HCT in Brazil. These results support the use of either Haplo or MUD grafts as a reasonable alternative for patients lacking an HLA-matched sibling donor. This study also demonstrates the feasibility of conducting multicenter observational studies in a developing country through collaboration between the Brazilian national transplantation society and the CIBMTR.
Central nervous system (CNS) tuberculosis is a post-primary form of tuberculosis. It has high mortality and morbidity rates despite early diagnosis and treatment. CNS tuberculosis can manifest as subacute/chronic meningitis, parenchymal tuberculous lesions, and spinal tuberculosis. Hematogenous spread of tuberculous bacilli to the brain results in the development of so called “rich foci” on the pial surface, ependyma, and grey-white matter junction. Rupture of these “rich foci” into the subarachnoid space triggers an intense granulomatous inflammatory reaction. Tuberculous meningitis can manifest as leptomeningitis or pachymeningitis. Intracranial parenchymal tuberculous lesions may present as tuberculoma, tuberculous abscess, cerebritis, rhombencephalitis, and encephalopathy, with atypical presentations not uncommon. Complications of CNS tuberculosis encompass hydrocephalus, syrinx formation, vasculitis, infarcts, neuritis, and enduring neurological deficits. Post-contrast 3D fluid-attenuated inversion recovery (FLAIR) and post-contrast T1 spin-echo sequences excel in detecting tuberculous meningitis compared to other conventional magnetic resonance imaging (MRI) sequences. In proton magnetic resonance spectroscopy (PMRS), the presence of a lipid peak at 1.3 ppm is indicative of tuberculous lesions. Magnetization transfer (MT) imaging enhances the detection of tuberculous lesions, as the magnetization transfer ratio (MTR) of tuberculous pathologies, owing to their high lipid content, is lower than that in bacterial or fungal pathologies and higher than that in viral pathologies. This review article delves into the various typical and atypical imaging presentations of CNS tuberculosis in MRI, along with recent advances in imaging techniques.
Background:The proximity of optic nerves to the posterior paranasal sinuses (PNS) is a critical consideration in preventing optic nerve injuries during functional endoscopic sinus surgery.Methods:A retrospective cross-sectional study was conducted on 367 patients aged 13 years and above. Four radiologists, each with 2-6 years of experience, evaluated computed tomography scans of the PNS and the head of these patients. The optic nerves were classified into four types based on DeLano's classification, and their respective prevalence rates were determined. Additionally, the prevalence of optic nerve dehiscence and pneumatization of the anterior clinoid process was assessed.Results:A total of 734 optic nerves were evaluated and categorized into four groups as per DeLano's classification. The most common type was classified as type 1 optic nerve, representing 65.4% of all optic nerves. Types 2, 3, and 4 optic nerves accounted for 16.9, 8.6, and 9.1%, respectively. The prevalence rates of type 1, type 2, type 3, and type 4 optic nerves were 76.6, 24.5, 12.3, and 14.4%, respectively. Optic nerve dehiscence was observed in 14.3% of cases, with a prevalence of 21.2% in the study. Type 3 optic nerves were most commonly associated with dehiscence, with 49.2% of them showing dehiscence in their course through the ethmoid or sphenoid sinus. The prevalence of pneumatization of the anterior clinoid process in the study population was 28.3%, with type 3 optic nerves being the most frequently associated.Conclusion:An understanding of the relationship between optic nerves and posterior PNS, as well as awareness of optic nerve dehiscence, is essential in preventing injuries during sinus surgeries. Type 1 optic nerve predominates among Nepalese patients visiting our hospital.
