Follow-up Of Adult Patients Research Articles

Non-lesional epilepsy does not necessarily convey poor outcomes after invasive monitoring followed by resection or thermal ablation

ABSTRACT Objective We aimed to compare outcomes including seizure-free status at the last follow-up in adult patients with medically refractory focal epilepsy identified as lesional vs. non-lesional based on their magnetic resonance imaging (MRI) findings who underwent invasive evaluation followed by subsequent resection or thermal ablation (LiTT). Methods We identified 88 adult patients who underwent intracranial monitoring between 2014 and 2021. Of those, 40 received resection or LiTT, and they were dichotomized based on MRI findings, as lesional (N = 28) and non-lesional (N = 12). Patient demographics, seizure characteristics, non-invasive interventions, intracranial monitoring, and surgical variables were compared between the groups. Postsurgical seizure outcome at the last follow-up was rated according to the Engel classification, and postoperative seizure freedom was determined by Kaplan-Meyer survival analysis. Statistical analyses employed Fisher’s exact test to compare categorical variables, while a t-test was used for continuous variables. Results There were no differences in baseline characteristics between groups except for more often noted PET abnormality in the lesional group (p = 0.0003). 64% of the lesional group and 57% of the non-lesional group received surgical resection or LiTT (p = 0.78). At the last follow-up, 78.5% of the patients with lesional MRI findings achieved Engel I outcomes compared to 66.7% of non-lesional patients (p = 0.45). Kaplan-Meier curves did not show a significant difference in seizure-free duration between both groups after surgical intervention (p = 0.49). Significance In our sample, the absence of lesion on brain MRI was not associated with worse seizure outcomes in adult patients who underwent invasive intracranial monitoring followed by resection or thermal ablation.

Single-Chamber and Dual-Chamber Pacemaker Devices in Adults with Moderate and Complex Congenital Heart Disease: A Single Tertiary Referral Center Experience.

The number of device implantation procedures has increased in adult patients with congenital heart disease (ACHD). Despite significant improvements in materials and implantation techniques, these patients are exposed to higher risk of device related complications than general population. Herein, we describe our single tertiary referral center experience on transvenous pacemaker (PM) implantation and follow-up in adult patients with moderate and complex congenital heart disease (CHD) as limited data are available on long-term outcome. We considered all adults with moderate and complex CHD aged more than 16 years who underwent transvenous single-chamber and dual-chamber PM implant for sinus node dysfunction or atrioventricular block between January 2013 to December 2022 at our Unit. Seventy-one ACHD patients were included in the study (mean age 38.6 ± 15.2 years, 64% with moderate CHD, 36% with complex CHD). Among 32 patients implanted with a dual chamber PM (DDD PM), 4 devices were reprogrammed in VDD mode, 3 in VVI and 2 in AAI mode during follow-up because of lead dysfunction or permanent atrial arrhythmia. In addition, 26 patients had a single chamber PM (AAI or VVI PM) and 13 patients had single-lead pacing system with a free-floating atrial electrode pair (VDD PM). Just one of 13 single-lead VDD PM was reprogrammed in VVI mode due to a low atrial sensing. In DDD PM group, 10 re-interventions were needed due to lead dysfunction (8 cases) and lead-related infective endocarditis (2 cases). Only 3 patients in the single-lead PM group developed lead dysfunction with 2 re-interventions needed, but no infective endocarditis was reported. The rate of long-term complications is high in moderate and complex ACHD with transvenous PM devices, and it is mainly lead-related. In our experience, the less leads implanted, the less complications will occur. Considering the heterogeneity of the ACHD population, transvenous single-chamber or dual-chamber PM device implantation should always be tailored on the single patient, balancing risks and benefits in this complex population.

A comparative trial of blood pressure monitoring in a self-care kiosk, in office, and with ambulatory blood pressure monitoring

BackgroundAutomated measurement of blood pressure (BP) in designated BP kiosks have in recent years been introduced in primary care. If kiosk blood pressure (BP) monitoring provides results equivalent to in-office BP or daytime ambulatory BP monitoring (ABPM), follow-up of adult patients could be managed primarily by self-checks. We therefore designed a comparative trial and evaluated the diagnostic performance of kiosk- and office-based BP (nurse- versus physician-measured) compared with daytime ABPM.MethodsA trial of automated BP monitoring in three settings: a designated BP kiosk, by nurses and physicians in clinic, and by ABPM. The primary outcome was systolic and diastolic BP, with respective diagnostic thresholds of ≥135 mmHg and/or ≥ 85 mmHg for daytime ABPM and kiosk BP and ≥ 140 mmHg and/or ≥ 90 mmHg for office BP (nurse- and physician-measured).ResultsCompared with daytime ABPM, mean systolic kiosk BP was higher by 6.2 mmHg (95% confidence interval [CI] 3.8–8.6) and diastolic by 7.9 mmHg (95% CI 6.2–9.6; p < 0.001). Mean systolic BP taken by nurses was similar to daytime ABPM values (+ 2.0 mmHg; 95% CI − 0.2–4.2; p = 0.071), but nurse-measured diastolic values were higher, by 7.2 mmHg (95% CI 5.9–9.6; p < 0.001). Mean systolic and diastolic physician-measured BPs were higher compared with daytime ABPM (systolic, by 7.6 mmHg [95% CI 4.5–10.2] and diastolic by 5.8 mmHg [95% CI 4.1–7.6]; p < 0.001). Receiver operating characteristic curves of BP monitoring across pairs of systolic/diastolic cut-off levels among the three settings, with daytime ABPM as reference, demonstrated overall similar diagnostic performance between kiosk and nurse-measured values and over the curve performance for physician-measured BP. Accuracy with nurse-measured BP was 69.2% (95% CI 60.0–77.4%), compared with 65.8% (95% CI 56.5–74.3%) for kiosk BP.ConclusionsIn this study kiosk BP monitoring was not comparable to daytime ABPM but could be an alternative to in-office BP monitoring by trained nurses. The diagnostic performance of kiosk and nurse-measured BP monitoring was similar and better than that of physician-measured BP.Trial registrationClinicalTrials.gov (NCT04488289) 27/07/2020.

Role of Lung Ultrasonography in Follow up of Adult Patients with Corona Virus Disease 2019

Role of Lung Ultrasonography in Follow up of Adult Patients with Corona Virus Disease 2019

Right atrial performance of adult patients with repaired tetralogy of fallot

Abstract Background Patients with repaired Tetralogy of Fallot (rToF) present anatomic and hemodynamic sequelae which may impact the right heart mechanics. Right ventricular adaptation to prolonged loading conditions should not be considered in isolation from the right atrium, because the atrial function affects that of the ventricle. Purpose This study aims to describe the right atrial performance using the echocardiographic right atrial longitudinal strain in a population of adult patients with rToF. Methods Echocardiographic images of adult patients (&amp;gt;18 years old) with rToF were retrospectively reviewed, and atrial reservoir (rRAS), conduit (cRAS), and contractile (aRAS) right atrial longitudinal strain were calculated. A group of healthy subjects (CTR) with comparable sex, age, and body surface area was included for comparison. Invasive cardiac catheterization data were also collected for patients with rToF. Results Sixty patients were included in the study: 30 with rToF (age 34 ± 9 years old) and 30 healthy subjects (age 34 ± 11 years old). Patients with rToF presented a lower value of rRAS, cRAS, and aRAS when compared to CTR (rRAS: rToF 20.83 ± 8.44% vs CTR 36.22 ± 9.53%, p&amp;lt;0.0001; cRAS: rToF -11.22 ± 6.41% vs CTR -22.67% ± 8.88%, p&amp;lt;0.0001; aRAS: rToF 9.67 ± 5.94% vs CTR 14.28 ± 6.35%, p=0.03). rRAS presented a good positive correlation with systolic peak velocity at tissue doppler imaging (p=0.006) and a trend toward positive correlation with right ventricle global longitudinal strain (p=0.08) and with the tricuspid annular plane systolic excursion (p=0.07). No correlation was found between invasive right ventricle end-diastolic and -systolic pressure and echocardiographic right atrial longitudinal strain parameters. Conclusion Adult patients with rToF presented a lower value of right atrial longitudinal strain, indicating an impaired atrial performance. Right atrial longitudinal strain provides additional insight for the comprehensive evaluation of right heart mechanics and should be systematically evaluated during the follow-up of adult patients with rToF.

ESTRO/ESGO/SIOPe Guidelines for the management of patients with vaginal cancer

Primary vaginal malignancies are rare, comprising only 2% of all female genital tract malignancies in adults and 4.5% in children. As part of its mission to improve the quality of...

ESTRO/ESGO/SIOPe guidelines for the management of patients with vaginal cancer

Primary vaginal malignancies are rare, comprising only 2% of all female genital tract malignancies in adults and 4.5% in children. As part of its mission to improve the quality of care for women with gynecological cancers across Europe, the European Society of Gynaecological Oncology (ESGO) jointly with the European Society for Radiotherapy & Oncology (ESTRO) and the European Society of Pediatric Oncology (SIOPe) developed evidence-based guidelines in order to improve the management of patients with vaginal cancer within a multidisciplinary setting.ESTRO/ESGO/SIOPe nominated practicing clinicians who are involved in the management of vaginal cancer patients and have demonstrated leadership through their expertise in clinical care and research, their national and international engagement and profile as well as dedication to the topics addressed to serve on the expert panel (13 experts across Europe comprising the international development group). To ensure that the statements were evidence based, the current literature was reviewed and critically appraised. In the case of absence of any clear scientific evidence, judgment was based on the professional experience and consensus of the international development group. Prior to publication, the guidelines were reviewed by 112 independent international practitionners in cancer care delivery and patient representatives and their comments and input were incorporated and addressed accordingly.These guidelines cover comprehensively the diagnostic pathways as well as the surgical, radiotherapeutical and systemic management and follow-up of adult patients (including those with rare histological subtypes) and pediatric patients (vaginal rhabdomyosarcoma and germ cell tumours) with vaginal tumours.

Functional status and quality of life in young adults with cerebral palsy

Objective: To identify the sociodemographic characteristics, pain level, quality of life, functional state, mobility, and depression level in adults with cerebral palsy (CP). Material and methods. Our study included 78 adults with CP (mean age 24.75±7.66 years, 40.5% males) and 79 control subjects (mean age 26.74±6.72 years, 38.5% males). The quality of life, depression, and mobility of all participants were evaluated. In addition, functional status, functional independence and activity level were evaluated in the adult CP group. The depression level was determined by the Beck Depression Inventory (BDI), the mobility level was identified via Rivermead Mobility Index (RMI), and the quality of life was evaluated by the Short Form-36 (SF-36). The functional level of adults with CP was assessed with Gross Motor Function Classification System. Functional independence and activity level were evaluated using the Functional Independence Measure scale (FIM). Pain level was assessed with Visual Analogue Scale (VAS). Results. The patient and control groups were statistically different in terms of their educational status, marital status, duration of marriage, employment status, and monthly income (p&lt;0.05). SF-36 summary scale scores and subgroup scores, as well as RMI and FIM scores of CP patients, were lower than in the control group. In addition, we revealed a statistically significant positive correlation of FIM scores with SF-36 physical and mental components, along with a statistically significant negative correlation of VAS with FIM, and of FIM with GMFCS: p&lt;0.001, r= 0.450; p=0.013, ^0.279; p=0.022, r= -0.257; p&lt;0.001, r= -0.741, respectively. Conclusion. We established that the quality of life, along with the mobility and functional levels, were lower in young adults with CP than in the control group, while the depression and pain levels were higher vs. control group. Hence, pain, depression, mobility, functional level, and quality of life should be assessed during the follow-up of adult patients with CP

Rare Cystic Hygroma of the Axilla and Breast in Adults, Case Report, Long-Term Follow-Up and Literature Review: An Experience from Saudi Arabia

Cystic hygroma (CH) in adults is a rare condition. Most CH cases are diagnosed at birth or during the first two years of life. Head and neck are the most common sites. There is scanty information about the natural history and follow-up of adult patients with axillary and breast CH. Hence, we present this case to shed some light on the natural history, complications, and a new suggested modality of treatment to deal with the complications. We report a case of a 39-year-old female who presented after ten years of excision of the right axillary CH with massive breast edema and recurrence of cysts in the ipsilateral breast and axilla. The insertion treated the edema of a breast-peritoneal shunt. The procedure was performed by inserting a normal V-P shunt catheter without a reservoir through a small incision in the inframammary fold toward the breast and another tiny incision at 10 of the clock in the right breast for fixation in the breast parenchyma. A catheter was inserted through a small incision on the right lumbar spine without intraperitoneal fixation after the catheter was inserted subcutaneously. This case report shows that adult CH can reoccur. To our knowledge, this is the second case of CH concomitantly involving the breast and axilla. The shunt of the edematous fluid to the peritoneal cavity can give hope for intractable breast edema treatment.

Efficacy and Safety of Tacrolimus 0.1% for the Treatment of Facial Vitiligo: A Multicenter Randomized, Double-Blinded, Vehicle-Controlled Study

Topical calcineurin inhibitors are used off label in the treatment of vitiligo, and there is a lack of placebo-controlled, blinded studies to support their use. This study aimed to compare the efficacy of tacrolimus 0.1% ointment with that of the vehicle for repigmentation in adult patients with facial vitiligo. This study was a 24-week multicenter randomized parallel double-blind study with a 24-week post-treatment follow-up extension. Participants included were adult patients with recent facial vitiligo target lesions (<2 years) without changes in pigmentation or size over the previous 3 months. Patients received either tacrolimus 0.1% ointment or vehicle twice daily. The primary outcome was a therapeutic success, defined as a change ≥75% in the repigmentation of the target lesion between baseline and week 24, measured by ImageJ software. Secondary outcome measures were a variation of the physicians' global assessment scores and patients' satisfaction scores, safety data, and the rate of relapse at week48. A total of 42 patients were included. Therapeutic success was achieved in 65% of tacrolimus-treated patients versus 0% of vehicle-treated patients at week 24 (P < 0.0001). Only 40% of relapse was observed at 48 weeks. Twice-daily tacrolimus 0.1% ointment showed superior efficacy to that of the vehicle through the 24 weeks of intervention and 24 weeks of follow-up in adult patients with facial vitiligo. This study was registered at ClinicalTrials.gov (identifier: NCT02466997).

Diabetic Emergencies: Experience of a Tertiary Endocrine Center

Purpose: In this study, we aimed to retrospectively evaluate the demographic data, clinical features, laboratory data, precipitating causes of diabetic emergencies, complications in the follow-up of adult patients who applied to our hospital due to diabetic emergencies. Methods: The study included patients aged 18 years and older referred to a tertiary endocrine center with diabetic ketoacidosis (DKA), hyperosmolar hyperglycemic state (HHS) hypoglycemia between January 2010 and May 2018. Results: The study was carried out with 165patients, 69(41.8%) males, and 96(58.2%) females. The mean age of the patients was 43.8±20.4(18- 88). Of these patients, 77% (n=127) had DKA, 17% (n=28) had HHS and 6% (n=10) had hypoglycemia. Of the patients 55.2% (n=91) were type 1 DM, 44.8% (n=74) were type 2DM. When the precipitating causes of diabetic emergencies were examined, 32.7%(n=54) poor adherence to treatment and 32.1%(n=53) infection of the patients were involved. The new diagnosis was DM in 10.9% of the patients (n=18). The most common complication after treatment was hypopotassemia with 38.7% (n=60), but no complication was observed in the majority of patients (54.8%). In our study, total mortality was 1.8% and 11.1% in HHS patients. No mortality was found in DKA and hypoglycemia patients. Conclusion: Diabetic ketoacidosis is more common in DM patients than in other diabetic emergencies. Approximately 11% of patients do not have a known diagnosis of diabetes. Poor adherence to treatment and infection are the most important precipitating causes of the diabetic emergency. The mortality rate is very low with early diagnosis and correct treatment.

Stress perfusion cardiac magnetic resonance imaging to identify coronary aneurysms, ischaemia and fibrosis in adult patients with convalescent Kawasaki disease

Abstract Background Kawasaki disease is a common cause of coronary aneurysms in early adulthood. Non-invasive imaging plays a crucial role in the diagnosis and surveillance of these patients who are known to develop ischaemia, premature coronary artery disease and have poorer long-term health outcomes. Stress perfusion cardiac MRI (CMR) is considered the “gold standard” for the assessment of ischaemia and risk stratification of major adverse cardiovascular events in patients with coronary artery disease. Its use in the long-term follow-up of patients with Kawasaki disease is particularly attractive as it avoids the use of ionising radiation. However, data on its utility, together with magnetic resonance angiography (MRA) and late gadolinium enhancement (LGE) to identify ischaemia, coronary aneurysms, and fibrosis, over long-term follow-up in this population remains limited. Purpose To evaluate the diagnostic utility of comprehensive non-invasive stress perfusion CMR to identify inducible ischaemia, coronary aneurysms and myocardial fibrosis in adult patients with convalescent Kawasaki disease. Methods We performed a retrospective review of all adult patients in our Kawasaki service who underwent stress perfusion CMR with MRA and LGE as part of routine clinical care. Data collected included the presence of inducible perfusion defects, coronary anatomy and LGE. Data was compared to contemporary CT coronary angiography (CTCA). In patients who had repeated stress perfusion CMR, changes in perfusion over time were investigated. Results Seventeen patients underwent stress perfusion CMR (total 30 scans). Seven patients underwent ≥2 scans. Median age was 21 years; 14 patients were male. Five patients (30%) had areas of inducible hypoperfusion of which 3 also had LGE. A further 2 patients had LGE with no ischaemia. Coronary MRA was performed in 12 patients (71%) and identified 14 aneurysms. In 8 patients with both MRA and CTCA, detection of aneurysms was significantly correlated (Pearson's coefficient 0.776; P value 0.024). Of the 5 patients with ischaemia, 4 patients had previous CABG. All areas of ischaemia corresponded to persistent calcified aneurysms in the responsible artery. In the 7 patients with multiple perfusion CMR scans (median follow-up 47 months), 3 patients developed new ischaemia. Conclusions Long-term surveillance of coronary arteries in adult patients with a childhood history of Kawasaki disease is crucial in the early identification and management of complications. We show that stress perfusion CMR is a useful radiation-free technique for the long-term follow-up of these young patients and is able to identify the development of new ischaemia. Coronary MRA has good agreement in the identification of aneurysms when compared to CTCA. Little is reported in the literature regarding the use of a comprehensive CMR assessment in the follow-up of adult patients with Kawasaki disease and further studies are needed to validate this approach. Funding Acknowledgement Type of funding source: None

Predictive value of the modified Bhalla score for assessment of pulmonary exacerbations in adults with cystic fibrosis.

The objective of this study was to analyze the predictive value of the modified Bhalla score in high-resolution computed tomography (HRCT) for assessment of pulmonary exacerbations (PEx) in cystic fibrosis (CF) patients. We also describe the relationship between this score and pulmonary function test results. We performed a multicenter and prospective study where adult patients with CF were included consecutively over 18 months. All patients underwent HRCT with acquisition in inspiration and expiration. The results were analyzed by an expert radiologist who assigned a modified Bhalla score value. Lung function was also assessed, and clinical variables were collected. Follow-up lasted approximately 1 year, and PEx were registered. The study population comprised 160 subjects selected from 360 CF patients monitored in the participating CF units. The mean age was 28 years, 47.5% were women, and mean forced expiratory volume in 1 s (FEV1) was 67.5%. The mean global modified Bhalla score was 14.5 ± 0.31 points. Pulmonary function test (PFT) results and the modified Bhalla score correlated well, mainly forced vital capacity (FVC) and FEV1. We constructed a statistical model based on the overall Bhalla score to predict the number of PEx. The overall modified Bhalla score can predict future PEx in CF patients. This useful tool can help to prevent PEx in higher risk patients. • Pulmonary function test results and the modified Bhalla score correlated well with FVC and FEV1. • The total modified Bhalla score can predict the number of exacerbations in adult CF patients. • Our findings highlight the need to establish a unified protocol for chest HRCT during the follow-up of adult patients with CF in order to anticipate possible complications and determine their impact on pulmonary function.

Pharmacist Medication Management of Adults with Attention Deficit: An Alternative Clinical Structure.

Attention-deficit/hyperactivity disorder (ADHD) is one of the most common psychiatric conditions in youth. This disorder can persist into adulthood, with an estimated prevalence of 4.4% to 5.2% in the US. To review adult ADHD diagnostic criteria, adult clinical presentation, and resulting impairments in function and to describe our adult psychiatry clinic's pharmacist-comanaged ADHD medication management program as a model to provide safe and effective care that is accessible, efficient, and well monitored. The program consists of 1) screening (urine toxicology, diagnostic evaluation, data collection) by physicians, 2) program participation and treatment agreement with establishment of care goals, and 3) patient maintenance and monitoring. Pharmacists in the Department of Psychiatry manage refills, distributing the clinical caseload among a broader clinician base. This program created a standardized protocol for assessment, referral, and follow-up of adult patients with ADHD, with close monitoring and titration of controlled medications, systematic use of screening measures, and a stimulant treatment contract. Development of this program and workflow model could increase care delivery efficiency, potentially improving patient satisfaction and outcomes. There is a great need to use alternative patient management strategies such as this to maintain access to high-quality care while there is a nationwide need for more psychiatric clinicians. We believe this program offers a solution to a component of this growing problem, and other clinical sites would benefit from such a program. Next steps include analysis and publication of results of implementation, including patient outcomes, engagement in treatment, and satisfaction.

P334Prospective FU in various subtypes of cardiomyopathies: insights from the EORP Cardiomyopathy Registry of the ESC

Abstract Background The EORP Cardiomyopathy Registry is a prospective, observational, multinational registry of consecutive patients with cardiomyopathies. The objective of this report is to describe the outcomes at one year of follow-up of adult patients (&gt;18 years old) enrolled in the registry. Methods A total of 3,208 patients (median age: 55.0 (43.0; 64.0) years, males: 65.1%) were recruited at baseline. Follow-up data at 1 year were obtained in 2,713 patients (84.6%), including 1,420 with hypertrophic (HCM), 1,105 dilated (DCM), 128 arrhythmogenic right ventricular (ARVC) and 60 restrictive cardiomyopathy (RCM). Results Improvement of symptoms (NYHA, chest pain, syncope) was globally observed over time (p&lt;0.001 for each). Additional invasive therapeutics were performed during follow-up: implantation of ICD (primary prevention) (N=109 patients, 5.2%), pacemaker (N=28, 1.2%), heart transplant (N=30, 1,1%), ablation for atrial or ventricular arrhythmia (0.5% &amp; 0.1%). The proportion of patients with history of AF increased from baseline to FU in 3.6% (from 28.2% to 31.8%). ICD therapy at 1 year was delivered more frequently in ARVC then in DCM, HCM and RCM (11.4%, 9.0%; 8.1%, 0% respectively for primary prevention). Major cardiovascular events (MACE) occurred in 29.3% of RCM, 10.5% of DCM, 7.9% of ARVC and 5.3% of HCM. MACE were globally higher in index patients compared to relatives (10.8% vs 4.4%, p&lt;0.001). When considering geographical areas, MACE were higher in East Europe (13.1%) and lower in South Europe (5.3%) (univariate); heart transplant was higher in West Europe (2.40%) and lower in South Europe (0.25%) (univariate). Conclusions Despite symptomatic improvement in most cases, there is still a significant burden of arrhythmic and heart failure events in patients with cardiomyopathies. Outcomes were different not only according to cardiomyopathy subtypes but also in relatives versus index patients. Acknowledgement/Funding None

Correction to: SEOM clinical guidelines for anaplastic gliomas (2017).

The SEOM/GEINO clinical guidelines provide recommendations for radiological, and molecular diagnosis, treatment and follow-up of adult patients with anaplastic gliomas (AG). We followed the 2016 WHO classification which specifies the major diagnostic/prognostic and predictive value of IDH1/IDH2 missense mutations and 1p/19q codeletions in AG. The diagnosis of anaplastic oligoastrocytoma is discouraged. Surgery, radiotherapy and chemotherapy with PCV or TMZ are the first-line standard of care for AG with slight modifications according to molecular variables. A multidisciplinary team is highly recommended in the management of these tumors.

Evaluation of the epidemiological profile and oral rehabilitation of patients with buccomaxillofacial trauma

Objective: To obtain the epidemiological profile and follow the rehabilitation of patients with buccomaxillofacial trauma attended at a hospital emergency service. Material and Methods: The study consisted of the analysis of medical charts, evaluation and follow-up of adult patients, over 18 years of age, in the preoperative and postoperative period from August 2015 to July 2016. Of the 114 charts examined, all had their epidemiological profile evaluated, but only 45 patients underwent a maxillofacial surgical procedure. During the clinical evaluation, post-trauma conditions were recorded before treatment (T1) and 48 hours after surgical treatment (T2). Results: The age group most affected by buccomaxillofacial trauma was between 20 and 31 years, especially in the male gender. The mandible and nasal bones were the most affected by trauma. The limitation of mouth opening was the main consequence and the levels of buccal opening before and after treatment of mandible fractures were significantly different. Conclusions: The profile of patients with facial trauma was composed of men, aged between 21 and 30 years, motorcycle traffic accidents and physical aggression being the predominant causal factors. The facial bones most affected by the trauma were the jaw and the nasal bones. The limitation of mouth opening was a consequence of the trauma of the mandibular region. Immediate treatment of fractures that affected the mandible provided the restoration of the maximum opening, occlusion and homeostasis of the stomatognathic system in the postoperative patients.KEYWORDS Trauma of head; Traumatology; Fracture fixation.

SEOM clinical guidelines for anaplastic gliomas (2017)

The SEOM/GEINO clinical guidelines provide recommendations for radiological, and molecular diagnosis, treatment and follow-up of adult patients with anaplastic gliomas (AG). We followed the 2016 WHO classification which specifies the major diagnostic/prognostic and predictive value of IDH1/IDH2 missense mutations and 1p/19q codeletions in AG. The diagnosis of anaplastic oligoastrocytoma is discouraged. Surgery, radiotherapy and chemotherapy with PCV or TMZ are the first-line standard of care for AG with slight modifications according to molecular variables. A multidisciplinary team is highly recommended in the management of these tumors.

Diagnostic value of 18F-FDG-PET/CT for the follow-up and restaging of soft tissue sarcomas in adults.

The purpose of this study was to evaluate the clinical utility of 2-[18F] fluoro-2-deoxy-D-glucose (18FDG) positron emission tomography (PET)/computed tomography (CT) (18F-FDG-PET/CT) in the follow-up of adult patients with soft tissue sarcomas. We prospectively evaluated 37 consecutive patients with known soft tissue sarcoma with 18F-FDG-PET/CT examination for suspected recurrence of disease. They were 21 men and 16 women with a mean age of 49.6±10.6 (SD) years (range, 34-75years). The sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) and accuracy of 18F-FDG-PET/CT examination were calculated on a per patient basis. 18F-FDG-PET/CT showed an overall diagnostic accuracy of 91.8%, sensitivity of 90% and a specificity of 100%. The positive predictive value and negative predictive value were 100 and 70%, respectively. The 18F-FDG-PET/CT interpretations were correct in 34/37 patients (91.8%). Incorrect interpretations occurred in three patients (8.1%). Reasons for false negative findings were low 18F-FDG uptake of local recurrence in one patient and low 18F-FDG uptake of subcentimetric inguinal lymph node metastases. 18F-FDG-PET/CT has a high diagnostic value in the follow-up of patients with soft tissue sarcoma.

Noninvasive techniques for the diagnosis of anomalous origin of the left coronary artery from the pulmonary artery in adult patients

Background Anomalous origin of the left coronary artery from the pulmonary artery (ALCAPA) is a rare congenital cardiac anomaly which requires surgical treatment, which improves left ventricular function and clinical outcomes. The definitive diagnosis of ALCAPA is based on coronary angiography, however, noninvasive visualization of the origin of the coronary artery is often helpful in the diagnosis of ALCAPA.Objectives The purpose of this study was to evaluate noninvasive techniques for the diagnosis of ALCAPA, and present the clinical outcomes in adults after surgical correction of ALCAPA.Methods Medical charts of five patients with ALCAPA treated at the John Paul II Hospital in Cracow between 2004 and 2012 were analyzed retrospectively. Noninvasive imaging techniques were used to visualize coronary vessels preoperatively. Patients were followed one year after the operation with echocardiograms and assessment of the New York Heart Association functional class.Results Computed tomography showed ALCAPA in four patients. Magnetic resonance imaging showed abnormal left ventricle remodeling suggestive of ischemia of the anterior cardiac wall. Myocardial perfusion imaging revealed ischemia of the middle and periapical segments of the anterior and anterolateral wall of the left ventricle in two patients. Postoperatively, patients had symptomatic improvement, but there was no statistically significant difference in mean ejection fraction.Conclusions Noninvasive techniques can be used to visualize the origin of the coronary arteries and characterize their morphology. Long-term follow-up of adult patients after surgical correction of ALCAPA is not well documented in the literature, but surgical treatment revealed beneficial short-term effects and symptoms relief.