Rheumatic fever continues to be a significant problem in Australian Aboriginal communities and developing countries worldwide. Early diagnosis could facilitate the institution of penicillin prophylaxis resulting in the prevention of recurrences of rheumatic fever. An overlapping biotinylated peptide bank of 82 peptides, based on the known sequence of Streptococcus pyogenes M24 protein, was used in a standard enzyme immunoassay. A total of 82 sera were tested from both aboriginal and non-aboriginal subjects with clinically proven rheumatic fever, rheumatic heart disease and matched controls. Two peptides with significant sequence homology at the C-terminal end were found to be discriminatory between aboriginal cases and controls. It is proposed that these peptides could be the basis of a serological test for rheumatic fever.

To evaluate feasibility, safety and efficacy of a combination of screw fixation and cementoplasty for pathologic bone fracture. In this single-center prospective study, all consecutive percutaneous screw fixations under assisted CT guidance for palliation and fracture treatment of pathologic bone fracture were reviewed from July 2019 to February 2021. The primary outcome measure was the procedures’ technical success, defined as the correct placement of the screw(s), without any complications. Secondary outcome measures were the safety, the procedures’ early analgesic effects and impacts on quality of life at 4 weeks. Technical success was achieved in 11/11 procedures (100%) among 11 patients. No major complications attributable to the procedure were noted. The mean pain scored significantly decreased at the initial follow-up: 8.0 ± 2.7 versus 1.6 ± 2.5 (p < 0.05). Opioid doses were statistically lower after procedure: 70.9 ± 37 versus 48.2 ± 46 mg/day (p < 0.05). The mean EQ5D score had significantly increased by the early post-procedure consultation: 42.5 ± 13.6 vs 63.6 ± 10.3 (p < 0.05). Combination of percutaneous screw fixation and cementoplasty for pathologic bone fracture is feasible and safe. It is efficient to reduce pain, decrease the consumption of opioids and improve the quality of life at 4 weeks after the procedure.

BACKGROUND AND PURPOSE:Classification of deep (D), superficial (S) MCA territories and their junctional vascular area (the internal border zone, IBZ) can help to identify patients most likely to benefit from aggressive reperfusion therapy after stroke. We tested the prognostic value of an IBZ injury compared to DWI-ASPECTS and infarct volume. MATERIALS AND METHODS:DW lesions of 168 patients with acute (4.2±6.5 h) MCA strokes were retrospectively examined and manually delineated. Patients with haemorrhagic transformation or other neurological diseases were excluded. Clinical data were recorded within 24 h following symptom onset and 48 h for patients who benefited from reperfusion therapy. The occurrence of an IBZ injury was determined using a standardized stereotaxic atlas. Performance to predict a good outcome (mRS<3 at 3 months) was estimated through ROC curves for DWI-ASPECTS≤6, lesion volume≥100 mL and IBZ injury. Logistic regression models were performed to estimate independent outcomes for infarct volume and IBZ injury. RESULTS:Infarcts involving the IBZ were larger (94.9±98.8 mL vs. 30.2±31.3 mL), had higher NIHSS (13.8±7.2 vs. 7.2±5.7), more frequent MCA occlusions (64.9% vs. 28.3%), and worse outcomes (mRS 3.0±1.8 vs. 1.9±1.7), and were less responsive to IVtPA (34±47% vs. 55±48% of NIHSS improvement). The area under the ROC curves was comparable between the occurrence of IBZ injury (0.651), ASPECTS≤6 (0.657) and volume≥100 mL (0.629). Logistic regression analyses showed an independent effect of an IBZ injury, especially for superficial MCA strokes and for patients who benefited from reperfusion therapy. CONCLUSION:An IBZ injury is an early and independent marker of stroke severity, functional prognosis and treatment responsiveness.

Objective Retrievable inferior vena cava filters (IVCF) have been developed because permanent filters have been associated with an increased risk of recurrent deep venous thrombosis. There is no data on the interactions of IVCF with the inferior vena cava (intrafilter thrombi, insertion through the venous wall) even though this may alter the course after retrieval of the IVCF. Methods A review of 85 consecutive patients undergoing retrieval of IVCF placed at a single center was performed from January 1, 2010 and December 31, 2014. Inferior vena cava filter were examined for presence of intrafilter thrombus at time of retrieval. Filter position and presence of intraluminal thrombus were examined. Patient outcomes, including recurrence of deep vein thrombosis (DVT) and death, were captured at 3 month followup. Results Eighty five patients were identified, with intrafilter thrombi found in 69 (81%) patients and venous wall fragments found in 75 (88%) patients. However, their presence was not associated with an increased risk of recurrent venous thromboembolism (VTE) or death during follow up. Conclusions Intrafilter thrombi and venous wall fragments are frequently found in removed IVCF but are not associated with a worse prognosis. They may not modify the therapeutic management of patients.

Abstract Background Patients with spontaneous or traumatic active mesenteric bleeding cannot be treated endoscopically. Transarterial embolization can serve as a potential alternative to emergency surgery. Literature on transarterial embolization for mesenteric bleeding remains very scarce. The objective of this study was to evaluate the safety and efficacy of transarterial embolization for mesenteric bleeding. We reviewed all consecutive patients admitted for mesenteric bleeding to the interventional radiology department, in a tertiary center, between January 2010 and March 2021. Mesenteric bleeding was defined as mesenteric hematoma and contrast extravasation and/or pseudoaneurysm visible on pre-operative CT scan. We evaluated technical success, clinical success, and complications. Results Among the 17 patients admitted to the interventional department for mesenteric bleeding, 15 presented with active mesenteric bleeding requiring transarterial embolization with five patients with hemodynamic instability. Mean age was 67 ± 14 years, including 12 (70.6%) males. Technical success was achieved in 14/15 (93.3%) patients. One patient with technical failure was treated by percutaneous embolization with NBCA-Lipiodol mixture. Three patients (20%) had early rebleeding: two were treated by successful repeat embolization and one by surgery. One patient (6.7%) had early death within 30 days and two patients (13.3%) had late death after 30 days. Mean length of hospitalization was 12.8 ± 7 days. There were no transarterial embolization-related ischemic complications. Conclusion Transarterial embolization is a safe and effective technique for treating mesenteric bleeding even in patients with hemodynamic instability. Transarterial embolization doesn’t close the door to surgery and could be proposed as first intention in case of mesenteric bleeding.

Objective: To evaluate the clinical impact of the tract embolization technique using gelatin sponge slurry after percutaneous CT-guided lung biopsy.Methods: We retrospectively compared coaxial needle CT-guided lung biopsies performed without emboli-zation (100 patients) and with the tract embolization technique using a mixture of iodine and gelatin sponge slurry (105 patients) between June 2012 and July 2020. Uni-and multivariate analyses were performed between groups to determine risk factors of pneumothorax.Results: Patients with gelatin sponge slurry tract embo-lization had statistically lower rates of pneumothorax ((17.1% vs 39%, p < 0.001). In univariate analysis, tract embolization (OR = 0.32, CI = 0.17-0.61 p<0.001) and nodule size >2 cm (OR = 0.33 CI = 0.14-0.8 p = 0.013) had a protective effect on pneumothorax. The puncture path lengths > 2-20 mm and >20 mm were risk factors for pneumothorax (OR = 3.35 IC = 1.44-8.21 p = 0.006 and OR = 4.36 CI = 1.98-10.29 p<0.001, respectively). In multivariate regression analysis, tract embolization had a protective effect of pneumothorax (OR = 0.25, CI = 0.12- 0.51, p < 0.001). The puncture path lengths > 2-20 mm and >20 mm were risk factors for pneumothorax (p = 0.030 and p = 0.002, respectively).Conclusions: The tract embolization technique using iodinated gelatin sponge slurry is safe and considerably reduces pneumothorax after percutaneous CT-guided lung biopsy. Our results suggest that it could be use in clinical routine.Advances in knowledge: The systemic use of gelatin sponge slurry is safe and reduces considerably the rate of pneumothorax upon needle removal when CT-guided core biopsies are performed using large 16-18G coaxial needles.

Secondary lesions and hemopathy localized in sternal bone may be responsible for persistent pain and resistant to classical analgesics. Surgical treatment is not applicable in these cases. We report on 2 cases of sternal osteosynthesis by internal cemented screw fixation, under fluoroscopy and CT scan control, without complication and with clear, immediate reduction of pain. Cementoplasty alone does not appear to be the most appropriate approach for treating lytic sternal lesions which are subject to traction and distraction forces, and resistant to analgesics. Discussion of these 2 cases demonstrate that internal cemented screw fixation allows for rapid management of pain in lytic lesions of the sternum in cancer-related context and should be more widespread in the medical community.

Introduction: Bleeding secondary to peristomal varices is a rare but potentially fatal complication of portal hypertension. TIPS is its first-line etiologic treatment in the setting of cirrhosis with portal hypertension. However, TIPS is not always feasible, especially in cases of contraindication or portal trunk occlusion. Case presentation: A patient of 63-year old male was referred for persistent peristomal variceal bleeding. He had a past history cirrhosis with portal hypertension due to alcohol consumption and more recently, rectal cancer with metachronous liver metastasis. He was treated by proctectomy with placement of a stoma in the left flank. An evaluation CT scan showed a tumour-like occlusion of the portal vein, the origin of which is uncertain.He was regularly referred to the emergency department for peristomal bleeding with anaemia, without haemodynamic instability. CT-scan angiogram confirmed ectopic peristomal varices without active bleeding. After multidisciplinary meeting, a minimal invasive approach was decided. Under local anaesthesia and ultrasoung guidance, the varicose vein was punctured by direct percutaneous access using a 22G-needle, and embolized using a mixture of N-Butyl-Cyanoacrylate and Lipiodol. The patient had no complication, and no recurrent bleeding occurred after more than 6 months of follow-up. He was discharged from the hospital 8 days later. Conclusion: The percutaneous approach is a simple and effective technique. This approach should be the first line treatment when TIPS is not indicated.

Distinction between deep and superficial middle cerebral artery (MCA) territories and their junctional vascular area (the internal borderzone or IBZ) constitutes a predictor of stroke patient outcome. However, the IBZ boundaries are not well-defined because of substantial anatomical variance. Here, we built a statistical estimate of the IBZ and tested its vulnerability to ischemia using an independent sample. First, we used delineated lesions of 122 patients suffering of chronic ischemic stroke grouped in deep, superficial and territorial topographies and statistical comparisons to generate a probabilistic estimate of the IBZ. The IBZ extended from the insular cortex to the internal capsule and the anterior part of the caudate nucleus head. The IBZ showed the highest lesion frequencies (~30% on average across IBZ voxels) in our chronic stroke patients but also in an independent sample of 87 acute patients. Additionally, the most important apparent diffusion coefficient reductions (−6%), which reflect stroke severity, were situated within our IBZ estimate. The IBZ was most severely injured in case of a territorial infarction. Then, our results are in favour of an increased IBZ vulnerability to ischemia. Moreover, our probabilistic estimates of deep, superficial and IBZ regions can help the everyday spatial classification of lesions.

Chordomas are uncommon, bone, axial, or (rarely) extra-axial tumors that are malignant and frequently recur but less commonly metastasize. They usually affect adults, with a very small proportion being pediatric tumors. For children, such tumors present a different biology, since they are more common as scull rather than sacral tumors, with aggressive histological features, including a loss of SMARCB1/INI1 and a dismal prognosis. Histologically, chordomas, believed to derive from notochordal tissue, characteristically show physaliphorous cells in a myxoid or chondroid matrix. Dedifferentiated and poorly differentiated forms can be observed. Moreover, a grading scale for chordomas has been proposed. Cytokeratin, EMA, S100, and brachyury are expressed by most chordomas. These are chemo-resistant tumors, for which surgical resection and/or radiotherapy are the treatments of choice. In this review, the histological, immunohistochemical, molecular, and clinical data of chordomas are discussed.

La lésion musculaire des ischio-jambiers est une lésion très fréquente dans les sports avec une composante importante de sprint et d’accélération. L’objectif principal a été de rechercher une association entre la topographie des lésions des ischio-jambiers et le mécanisme lésionnel. Les objectifs secondaires ont été : (1) de réaliser une cartographie IRM de la localisation des lésions musculaires des ischio-jambiers ; (2) d’évaluer la variabilité inter observateur de l’analyse IRM d’une lésion des ischio-jambiers en comparant l’analyse d’un radiologue expérimenté « senior » vs un radiologue « junior ». Nous avons réalisé une étude de cohorte prospective, multicentrique, non interventionnelle. Une IRM de la cuisse a été réalisée, au plus tard 21jours après le traumatisme initial. La localisation IRM de la lésion a été analysée selon le muscle atteint, la structure anatomique touchée et la zone de la loge postérieure de la cuisse intéressée par la lésion (cette dernière était déterminée par sa distance par rapport à la tubérosité ischiatique). Chaque IRM a été étudiée par un radiologue « senior » puis relue en aveugle par le radiologue « junior ». Avant l’IRM, chaque patient remplissait un autoquestionnaire décrivant les circonstances et le mécanisme de la blessure. Au total, 23 IRM de lésions musculo-tendineuses des ischio-jambiers ont été analysées. La corrélation entre les mécanismes lésionnels et les localisations à l’IRM selon le nom, la zone de la loge postérieure de la cuisse touchée, la structure anatomique atteinte, a retrouvé (test de Fisher) respectivement une valeur de p à 0,58, 0,62 et 0,91. Le chef long du biceps fémoral et la jonction myo-tendineuse étaient le plus souvent touchés (69,6 % et 26 %). Le mécanisme lésionnel le plus fréquent était l’accélération (61 %), touchant les trois principaux muscles des ischio-jambiers, les trois zones de la loge postérieure de la cuisse et les deux principales structures anatomiques (la jonction myo-tendineuse et myo-aponévrotique). Les concordances inter observateurs entre radiologues senior et junior étaient de 0,91 pour l’analyse de la structure anatomique touchée, 0,93 pour celle de la zone de la loge postérieure de la cuisse atteinte et de 0,92 pour la gradation de la lésion en IRM selon la classification de Peetrons. Le biceps fémoral et la jonction myo-tendineuse semblent être des zones de faiblesse des ischio-jambiers.

Could a billion-sensor array detect dark matter all around us – through its gravity? Adam Mann weighs up an audacious proposal

Bone loss in anorexia nervosa (AN) is multifactorial; its mechanisms are not yet clearly understood and may vary depending on disease duration and severity. To determine to what extent adipokines may be involved in the bone alterations found in anorexic patients, we evaluated plasma levels for leptin, adiponectin and Pref-1 against other clinical and biological parameters in a population of anorexic patients split according to weight and bone status.Plasma concentrations of leptin, total adiponectin, high molecular weight (HMW) adiponectin, and Pref-1 were measured. The ratio of HMW adiponectin to total adiponectin — HMW (percentage) — was calculated. We divided our population into 5 groups with different phenotypes characterizing the severity of the disease and/or the severity of bone involvement: 1 – Normal BMD and body mass index (BMI): recovery from AN; 2 – Osteopenia (−2 < Z-score < −1) and BMI > 17 kg/m2; 3 – Osteopenia and BMI ≤ 17 kg/m2; 4 – Osteoporosis (Z-score ≤ −2) and BMI > 17 kg/m2; 5 – Osteoporosis and BMI ≤ 17 kg/m2.The study involved 80 anorexia nervosa patients. Mean BMI was 16.8 ± 2.4 kg/m2. No significant difference was found in total and HMW adiponectin plasma concentrations between the 5 groups. HMW (percentage) was significantly higher in group 5 compared to group 1. Leptin was significantly lower in groups 3 and 5 compared to the other groups. For the whole group femoral neck and hip BMD correlated negatively with total adiponectin and HMW adiponectin. No correlation was found between BMD (whatever the site) and plasma leptin. Multivariate analysis revealed that 2 factors — leptin and BMI — explained 10% of the variance in spine BMD. For femoral neck BMD, the 2 explanatory factors were BMI and total adiponectin which explained 14% of the variance in BMD. For total hip BMD, 27% of the variance in BMD was explained by 3 factors: leptin, BMI, and total adiponectin.Bone status in anorexia nervosa is mainly determined by BMI, leptin and adiponectin.

Diagnostic yield of pleural thoracentesis in case of suspected malignant pleural effusion (MPE) varies according to the histological type of the primary tumor (1,2), to the local extent of the disease (involvement of both visceral and parietal pleura) (3) and of course to the expertise (4). In patients with non-small cell lung cancer (NSCLC) and MPE, the evidence of malignant cells in the pleura is critical as their presence directly means that the patient presents with metastatic disease, and therefore he will be treated accordingly despite the fact that there is no evidence of other metastatic sites (5)

L’échographie apparaît comme un outil d’intérêt dans le diagnostic d’arthropathie à dépôts de pyrophosphate de calcium dihydraté (PPCD). Nous avions pour objectif de comparer la performance de l’échographie du poignet avec celle de la radiographie conventionnelle pour le diagnostic d’arthropathie à PPCD.Des patients avec présence de cristaux de PPCD dans le liquide synovial (genou, hanche, épaule, cheville ou poignet) ont été inclus de manière consécutive et comparés à des sujets témoins sans cristaux de PPCD dans le liquide articulaire. Selon les recommandations publiées, nous avons utilisé le terme de chondrocalcinose articulaire (CCA) pour les signes évocateurs d’arthropathie à PPCD retrouvés à l’imagerie. Chez tous les patients, l’analyse échographique et radiographique des poignets à la recherche d’une CCA a été réalisée en insu par deux opérateurs différents (un opérateur pour chaque modalité d’imagerie). Les deux examinateurs étaient en insu pour les données cliniques, l’analyse du liquide articulaire et les résultats de l’échographie ou de la radiographie.Un total de 32 patients ayant une arthropathie à PPCD et 26 témoins ont été inclus. Parmi les patients atteints d’une arthropathie à PPCD, 30 (93,7 %) ont présenté des signes échographiques de CCA et 17 (53,1 %) des signes radiographiques de CCA (p < 0,001). La sensibilité et la spécificité de l’échographie pour le diagnostic d’arthropathie à PPCD étaient respectivement de 94 % et 85 % ; le rapport de vraisemblance positif (RV+) s’élevait à 6,1. La sensibilité et la spécificité de la radiographie étaient respectivement de 53,1 % et 100 %. Au niveau des articulations, indépendamment de l’analyse du liquide articulaire, des signes échographiques de CCA ont été retrouvés dans 35 articulations sans CCA radiographique tandis que des signes radiographiques de CCA ont été observés dans 3 articulations sans CCA à l’échographie. Le coefficient de corrélation κ entre l’échographie et la radiographie pour la CCA était modéré : 0,33 [0,171–0,408].Notre étude souligne l’intérêt diagnostique de l’échographie du poignet dans le dépistage de l’arthropathie à PPCD, avec une sensibilité supérieure à celle de la radiographie pour l’identification des dépôts de cristaux de PPCD.

To assess predictors of response, according to hip MRI inflammatory scoring system (HIMRISS), in a sample of patients with hip osteoarthritis (OA) treated by hyaluronic acid (HA) injection.Sixty patients with hip OA were included. Clinical outcomes were assessed at baseline and three months after HA injection by WOMAC. On hip MRI performed before HA injection, bone marrow lesion (BML) and synovitis were assessed by HIMRISS by four readers. The inter-reader reliability of HIMRISS was for HIMRISS total, acetabular BML, femoral BML and synovitis-effusion respectively 0.86, 0.64, 0.83 and 0.78. Associations between MRI features and clinical data were assessed. Logistic regression (univariate and multivariate) was used to explore associations between MRI features and response to HA injection, according to WOMAC50 response at three months.In total, 45.5% of patients met WOMAC50 response. Five adverse events were reported. At baseline, WOMAC function correlated significantly to HIMRISS synovitis-effusion (r = 0.27, P = 0.03). In univariate analysis, BML femoral according to binary assessment (P = 0.025), HIMRISS BML femoral (P = 0.0038), HIMRISS BML acetabular (P = 0.042), HIMRISS total (P = 0.0092) were associated negatively with WOMAC50 response. In multivariate analysis, adjusted for age and BMI, HIMRISS femoral BML (P = 0.02) and HIMRISS total (P = 0.016) were negatively associated with response. At a HIMRISS threshold of < 15, 82% of patients were responders, with specificity SP = 0.97, sensitivity SN = 0.39, and positive and negative predictive values of 0.91 and 0.64, respectively.HIMRISS is reliable for total scores and sub-domains. It permits identification of responders to HA injection in hip OA patients.

La restriction étendue du cortex en séquence de diffusion peut s’expliquer par plusieurs mécanismes, vasculaire, cytotoxique, acidose ou accumulation de matériel amorphe. Devant une telle anomalie, le contexte, l’analyse du signal des noyaux gris centraux, de la substance blanche et la recherche d’une atrophie permettent d’orienter le diagnostic. À partir d’une analyse systématique de ces différents éléments, proposer une démarche diagnostique devant un hypersignal diffusion restrictif étendu du cortex. Les lésions post-traumatiques, ainsi que l’anoxie, sont orientées par le contexte. En cas d’atteinte associée des noyaux gris centraux, l’anoxie cérébrale, avec sa restriction et l’encéphalopathie hépatique chronique, avec un hypersignal T1 spontané bi-pallidale, peuvent être évoquées. Une anomalie du corps calleux oriente vers une encéphalopathie éthylique, carentielle. En cas d’atteinte de la substance blanche, l’anomalie de signal oriente vers une encéphalopathie infectieuse, comme le VIH, tandis que l’atrophie fait plutôt suspecter une démence neuro-dégénérative. Enfin, une atteinte corticale isolée ou associée aux thalami devra faire évoquer une maladie de Creutzfeld-Jacob. La prise en compte du contexte et l’analyse des lésions associées à un hypersignal diffusion restrictif du cortex, à type de modification de signal des noyaux gris centraux, de la substance blanche et de la trophicité permettent le plus souvent d’évoquer le diagnostic étiologique.

BACKGROUND:Malignant pleural effusion (MPE) is a common medical problem in lung cancer (LC). Pleural fluid cytology (PFC), chest computed tomography (CCT) and positron emission tomography (PET) findings are helpful as first line approach. The objectives of this study were to evaluate whether there is a correlation between PFC, CCT and PET in patients with MPE due to LC.METHODS:We selected patients from our electronic files. Data of PFC, pleural biopsy (PB), CCT and PET have been recorded and analyzed.RESULTS:A total of 101 consecutive patients (66 males, 65.3%) with a mean age of 66.2±31 years were selected. Types of LC were adenocarcinoma in 71 patients (70.2%), squamous in 13 (12.8%), small-cell in 12 (11.8%) and large cell in 5 (4.9%). CCT showed nodules in 6 (5.9%), pleural thickening in 8 (7.9%) and both in 17 (16.8%) patients. PFC was positive in 55/91 thoracentesis (60.4%) and 32/52 thoracoscopy (61.5%), while PB in 38/40 performed (95%). PET fixation was found in 32/47 (68%) patients who had MPE at diagnosis. When we associate PFC to CCT and PET findings, the yield in our study becomes 90%. No correlation was observed between CCT findings and PFC (P=0.62) between PFC and PET fixation (P=0.63) or between CCT and PET (P=0.06).CONCLUSIONS:In our cohort of LC patients with MPE, we observed a high sensitivity for PFC, while in most of the cases no findings were observed in CCT. PET had a relative low sensitivity. However, when all 3 methods were combined the yield was 90%.