Sensitive Mode Research Articles

High-Efficiency Finite Element Model Updating of Bridge Structure Using a Novel Physics-Guided Neural Network

An accurate finite element model (FEM) plays a critical role in the structural damage identification. However, due to the existence of the uncertainties, such as material properties and modeling errors, it always exists some gaps between the analytical FEM and experimental structure. While an artificial neural network (ANN)-based model updating methods have been widely adopted to narrow the gap and obtain a baseline FEM, it still faces inaccurate results and fails to meet the physical law. In this regard, the study proposes a novel physics-based loss function inspired by modal sensitivity analysis and incorporates it into the residual neural network, thereby forming a novel physics-guided neural network (PGNN) method. The mapping relationship between the input of structural responses and output of model updating variables is constrained to retain its physical meaning by guiding the training process instead of pure data association, which aims to improve the accuracy of the ANN-based method and achieve accurate and high-efficiency model updating. An experimental example of a continuous rigid frame bridge is adopted to verify the feasibility of the proposed method. Additionally, other common model updating methods, including moth-flame optimization and regularization method, are used to make a comparison. The noise-robustness of the proposed method is investigated as well. Compared to the existing method, the results illustrate that the proposed PGNN method can achieve better model updating and good noise-robustness under high uncertainties, which means the introduction of the physics-based loss function significantly enhances the parameters updating ability of the neural network. The proposed method exhibits high efficiency and promising potential for large-scale bridge structure model updating.

RETROSPECTIVE ANALYSIS OF DISCORDANT RESULTS BETWEEN UROVYSION FISH AND URINE CYTOLOGY IN THE DETECTION OF HIGH-GRADE UROTHELIAL CARCINOMA (HGUC): A STUDY OF 118 PATIENTS

Abstract Introduction/Objective Accurate detection of high-grade urothelial carcinoma (HGUC) relies on multiple diagnostic modalities, including UroVysion FISH and urine cytology; however, discordant results between these diagnostic tools can present a challenge. We present this study, scrutinizing the discordant results between UroVysion FISH and urine cytology to explore the potential factors that could contribute to discrepancies. Methods/Case Report A cohort of 118 patients, who underwent both UroVysion FISH and urine cytology testing for evaluation of HGUC, was selected from our cytopathology archives. Results of both the modalities were compared, and a retrospective review of original slides was done by experienced cytopathologists. Results (if a Case Study enter NA) Among the 118 cases, Urovysion FISH yielded positive results in 14 cases and negative in 104. In contrast, urine cytology reported 1 case as positive, 102 as negative, 10 as atypical (8 atypical and 2 rare atypical), and 5 as suspicious. Discordant findings were observed in 20 cases, accounting for 17% of the cases. After retrospective review of original slides, few cases were reclassified. 2 cases as atypical (initially labeled as negative), 2 cases as negative (initially labeled as atypical), 3 cases as positive (initially labeled as atypical/suspicious), 3 cases as suspicious (initially labeled as negative/atypical). Conclusion This reclassification highlights complexity of cytological interpretation, including the challenges of distinguishing between benign cellular alterations, reactive changes, ambiguous findings, suspicious features and malignant cytological changes. Integrating molecular and morphological assessment is essential for evaluation of urothelial carcinoma. Discrepancy between the two is an area which is open to study and can be related to differences in sensitivity and specificity of the testing modalities, sampling methods, variation in interpretation, limitations of testing modality and varying tumor characteristics. Review of clinical history, imaging studies, cystoscopy, and repeat testing may be considered in such cases for diagnostic accuracy.

Multicentre study to assess the performance of an artificial intelligence instrument to support qualitative diagnosis of colorectal polyps

ObjectiveComputer-aided diagnosis (CAD) using artificial intelligence (AI) is expected to support the characterisation of colorectal lesions, which is clinically relevant for efficient colorectal cancer prevention. We conducted this study to...

ThP1.1 - Unilateral Nipple Discharge: Contemporary Approaches to Investigation and Management across a Multi-site Trust

Abstract Nipple discharge, in the absence of a palpable breast lump, constitutes 3-9% of referrals to breast services[i],[ii]. While the ABS released updated guidelines on nipple discharge in 2019, a standardised management protocol is yet to be established. This study aims to scrutinize the efficacy of imaging (mammogram, USS, MRI) and nipple discharge cytology in predicting malignancy outcomes in patients with unilateral nipple discharge. Aims Determine the incidence of malignancy in women presenting with unilateral nipple discharge. Assess sensitivity, specificity, and positive predictive value of imaging modalities (mammogram, USS, MRI) and cytology. Methodology 110 patients presenting with unilateral nipple discharge between 11/2022-12/2023 were retrospectively analysed. Data encompassing patient demographics, diagnostic procedures, and outcomes were systematically collected. Results 31.6% underwent surgical intervention, revealing a malignancy rate of 5.6%. Positive predictive values for detecting malignancy were 75% for mammogram, 50% for ultrasound, and 66% for nipple discharge cytology. No patients underwent MRI or ductoscopy as part of investigations. Conclusion This study highlights variable diagnostic accuracy of imaging and cytology and the necessity for large-scale collaborative data to draw substantive conclusions. The National Unilateral Discharge Study is anticipated to provide comprehensive insights and contribute to the establishment of a national investigative framework for patients presenting with unilateral nipple discharge. [i] Vargas HI, Romero L, Chlebowski RT. Management of bloody nipple discharge. Curr Treat Options Oncol 2002; 3: 157–161. [ii] Seltzer MH. Breast complaints, biopsies, and cancer correlated with age in 10,000 consecutive new surgical referrals. Breast J 2004; 10: 111–117.

ADVANCES IN DIAGNOSIS AND TREATMENT OF CONGENITAL HEART DISEASE: A COMPREHENSIVE REVIEW

The purpose of this article is to provide a comprehensive review of recent advances in the diagnosis and treatment of congenital heart disease (CHD). CHD, which affects about 1% of live births worldwide, is still a major problem in pediatric cardiology. The most prevalent congenital cardiac defects—Ventricular Septal Defect (VSD), Tetralogy of Fallot (TOF), Coronary Artery Fistula, Coarctation of the Aorta (CoA), Aortic and Pulmonary Stenosis, Valve Insufficiency, Double Outlet Right Ventricle (DORV), Ebstein Anomaly, Transposition of the Great Arteries (TGA), Anomalous Venous Return, and Hypoplastic Left Heart Syndrome (HLHS) are all thoroughly examined in this review. The review examines current diagnostic and treatment strategies, highlighting the benefits, drawbacks, sensitivity, and specificity of several imaging modalities, including as CT, MRI, and echocardiography. It also discusses the historical evolution of treatment outcomes, emphasizing the tremendous advances in patient care and surgical procedures that have significantly mproved survival rates and quality of life for CHD patients.

Structural damage identification based on dual sensitivity analysis from optimal sensor placement

Structural damage identification (SDI) methods using incomplete modal information can avoid the extension for unmeasured degrees of freedom, but the absence of essential damage information often leads to the failure of SDI. To address this problem, a novel SDI method based on dual sensitivity analysis and optimal sensors placement technique is proposed in this study. Firstly, in the optimal sensor placement technique, an improved eigenvector sensitivity method combined with weighted modal kinetic energy is proposed, which enables the acquisition of eigenvector information related to damage sensitivity, and incorporates it into the modal strain energy sensitivity matrix to obtain the dual sensitivity analysis matrix. Then, the sparsity of structural damage is considered, and the L1 sparse regularization is selected and introduced into the dual sensitivity analysis damage equation for better SDI results. Finally, to assess the effectiveness of the proposed method, a series of numerical simulations and experimental verifications were carried out under different structural damage scenarios. The results indicate that the proposed method can efficiently localize and quantify the structural damage with minimal modal information in one single step.

Physics-guided deep learning based on modal sensitivity for structural damage identification with unseen damage patterns

Recently, wide attention has been paid to develop deep learning-based models for structural damage identification. However, in most of the studies, the pure deep learning-based structural damage identification methods lack physical interpretability and scientific consistency for generalization. Therefore, although such methods can achieve good damage identification results when data with similar damage patterns used for training and testing the network model, they usually give poor predictions in the unseen domain, i.e., the network’s extrapolation ability is limited. In this research, a physics-guided deep learning neural network (PGDLNN) is proposed by incorporating the physical loss constructed by structural modal parameters sensitivity analysis into the original Convolutional Neural Network (CNN) for structural damage identification. The model’s physical interpretability is improved, which can lead to more accurate damage identification results, especially in the domain with unseen damage patterns in training the network model. Numerical and experimental studies on simply supported beams are carried out to demonstrate the feasibility and effectiveness of the proposed method. The influences of measurement noise and incomplete measurements are also investigated. The results show that the incorporation of physical knowledge to deep learning model can enhance the generalization of the network, and hence improve the accuracy of damage severity quantification. This study not only performs damage localization and quantification simultaneously using the physics-guided deep learning neural network, but also demonstrates the superiority of incorporating physical knowledge into data-driven deep learning models for structural health monitoring.

High-risk human papilloma virus status & outcomes for penile squamous cell carcinoma: A single institution experience

ObjectivesThere is a paucity of data on North American cohorts of patients with penile squamous cell carcinoma (pSCC). Herein, we aimed to assess the sensitivity of various modalities to identify human papillomavirus (HPV) status, determine the prevalence of high-risk HPV–positivity, and evaluate the prognostic impact of relevant clinicopathologic variables. MethodsPatients with pSCC (n = 121) consecutively treated with partial/total penectomy (2000–2022) at a single institution were included. HPV status (based on immunohistochemistry [IHC], in situ hybridization [ISH], and panviral metagenomic sequencing [PMS]), histologic features, and outcomes were reviewed. Outcome events included death due to disease and progression. ResultsThe majority of patients were white (105/121, 86.8%). Thirty-seven (30.6%) were high-risk HPV–positive, and morphologic evaluation had a sensitivity of 97.3% (95% confidence interval [CI], 86.2–99.5) for predicting high-risk HPV status compared to IHC/ISH/PMS. Disease progression was more common among high-risk HPV–negative compared to high-risk HPV–positive patients (HR 2.74, CI 1.12–8.23, P = 0.03). Moreover, among high-risk HPV–negative patients, those with moderate-poorly differentiated tumors had increased disease-specific mortality (32.6%, CI 17.1–48.1) compared to those with well-differentiated tumors (0%). Among high-risk HPV–positive patients, those with basaloid morphology had lower disease-specific mortality (0% vs 14.4%, CI 0.0–33.1). ConclusionsWe demonstrate high-risk HPV–positivity in approximately one-third of patients with pSCC. Morphologic evaluation alone had a high sensitivity in correctly determining HPV status. Our results suggest that high-risk HPV status and morphologic features (differentiation in high-risk HPV–negative, and basaloid subtype in high-risk HPV–positive pSCC) may have prognostic value.

A fast analysis algorithm for structural vibration modal sensitivity

Vibration modal sensitivity analysis has a wide range of applications in structural optimization design, model correction, fault detection, and reliability analysis. The existing methods for calculating modal sensitivity mainly include modal superposition method, Nelson’s method, and some improved algorithms derived from them. However, the existing algorithms have the drawback of low computational efficiency when applied to modal sensitivity analysis of the large-scale structures. In view of this, the objective of this work is to develop a fast modal sensitivity analysis method that can more efficiently calculate the modal sensitivity of the large structures with thousands of degrees of freedom. This new sensitivity analysis technique integrates Sherman-Morrison-Woodbury formula, subspace iteration and forward-difference to achieve the goal of fast calculation. The innovations of the proposed method mainly include the following aspects. Firstly, the Sherman-Morrison-Woodbury formula is used to quickly calculate the perturbed flexibility matrix due to the minor modification in the structure. Then, the perturbed flexibility matrix is introduced into the subspace iteration method to calculate the perturbed modal parameters. Finally, the forward-difference algorithm is used to calculate the modal sensitivity. Two numerical examples are used to verify the superiority of the proposed modal sensitivity algorithm. Taking the 1952-bar structure as an example, the calculation time of the proposed algorithm is only 8.3 % and 18.2 % of that of the existing approximate modal superposition method and the improved Nelson’s method, respectively. In terms of calculation accuracy, the results obtained by the proposed method are exactly the same as the exact solution when the perturbation scale is set to 10−5. It is found that the proposed method significantly reduces computation time compared to the existing methods on the premise that the calculation accuracy is basically unchanged.

Agreement Between Transthoracic Echocardiography and Computed Tomography Pulmonary Angiography for Detection of Right Ventricular Dysfunction in Pulmonary Embolism.

Right ventricular dysfunction (RVD) is the main determinant of mortality in patients with pulmonary embolism (PE). Thus, guidelines recommend the assessment of RVD with transthoracic echocardiography (TTE) or computed tomography pulmonary angiography (CTPA) among these patients. In this study, we investigated the agreement between TTE and CTPA for the detection of RVD. This single-center retrospective study included patients who were diagnosed with CTPA and underwent TTE within the first 24 hours following the diagnosis. Two hundred fifty-eight patients met the inclusion criteria. In 71.3% (184) of them, CTPA and TTE agreed on both the presence and absence of RVD. There was a moderate agreement between the 2 tests (Cohen's kappa = 0.404, P <.001). The agreement between right ventricle dysfunction on TTE and the increased right ventricle/left ventricle (RV/LV) on CTPA was fair (Cohen's kappa = 0.388, P <.001). Three patients died due to PE, and another 5 patients required urgent reperfusion therapy. Overall, adverse outcomes occurred in 4% (8) of patients. The sensitivity of modalities in the detection of adverse outcomes was 100%. Transthoracic echocardiography was more specific compared to CTPA (43% vs. 28%). Statistically, flattening/bulging of the interventricular septum on TTE was significantly associated with adverse outcomes. No individual CTPA parameter was related to adverse outcomes. Both CTPA and TTE are reliable imaging modalities in the detection of RVD. However, TTE is more specific, and this may help in the identification and appropriate management of patients at higher risk of decompensation. A combination of CTPA parameters rather than individual RV/LV ratios increases the sensitivity of CTPA.

Comparative study between ultrasound and MR enterography in evaluation of Crohn’s disease

BackgroundCrohn’s disease is a chronic inflammatory bowel disease that can affect any part of the gut. Endoscopy is the gold standard for diagnosis, but it only assesses mucosal lesions. Magnetic resonance enterography (MRE) can assess disease presence and activity, but it has limitations such as motion sensitivity, long scan time, and high cost. Bowel sonography has been introduced as a non-invasive, practical, safe, and low-cost technique to assess disease activity and complications. In our study we aim to assess the comparability of ultrasound to MRE in evaluation of patients with Crohn’s disease, and its complications.ResultsTwenty-five patients with 38 Crohn’s disease affected segments were evaluated by bowel ultrasound (BUS) and MRI enterography (MRE), where BUS and MRE showed equivalent diagnostic performance for disease detection and localization (97.4%, 100%), for sensitivity and specificity of both modalities. Peri-mural fluid (89.5%, 94.4%) and mural stratification loss (100%, 100%) showed high sensitivity and specificity by BUS compared to MRE, while for assessment of mural vascularity, BUS showed high sensitivity and specificity for high grade vascularity (100%, 83.3%), but low sensitivity and high specificity for low and moderate vascularity (0%–62.5%, 81.8%) compared to MRE. Complications including fistulae and abscessed were all correctly identified in BUS compared to MRE.ConclusionBUS showed comparable results to MRE for identification, localization, assessment of findings related to disease activity, and complications in cases of Crohn’s disease rendering it a viable alternative to MRE.

Harmonic impedance optimization scheme for multi‐resonance systems to suppress resonance

AbstractHarmonic resonance is caused by harmonic source matching resonance frequency and presents the characteristics of decentralization and whole network in modern grids. The current resonance suppression methods mainly focus on reducing the harmonic source, and are suitable for single‐site and small‐scale grids. This paper presents a new method for suppressing parallel resonance at system level. The holistic harmonic resonance is suppressed by reducing the harmonic impedance. In addition, new resonances are prevented by weakening the coupling between resonance and non‐resonance frequencies. The resonance modal analysis and resonance frequency shift (RFS) are employed to optimize harmonic impedance. Simulation results indicate that the capacitance parameter has higher sensitivity and is theoretically more suitable for RFS. Considering the accuracy of modal frequency sensitivity, a variable‐limit genetic algorithm for iteration is proposed. The validity of the proposed method was verified using an IEEE 14‐bus test network.

Potential Advantage of Magnetic Resonance Imaging in Detecting Thoracic Wall Infiltration in Pleural Mesothelioma. A Retrospective Single Center Analysis.

Abstract Background Thoracic wall infiltration in pleural mesothelioma (PM) can be an important prognostic factor when determining the extent of resection. Currently, standardized imaging for restaging after neoadjuvant systemic therapy comprises contrast enhanced Computed Tomography (CT) or Positron Emission Tomography (PET/CT) scan. Aims However, thoracic Magnetic Resonance Imaging (MRI) could be a better discriminator of chest wall infiltration prior to surgery. To increase the preoperative staging accuracy, we introduced a MRI protocol at our center. Methods A retrospective analysis of this prospective new imaging protocol was performed from 07/2018 to 08/2023, including descriptive analysis for patient`s sex, age, nicotine consumption, asbestos exposure, histological subtype, TNM-stage, RECIST criteria and number of neoadjuvant therapy cycles. Preoperative restaging included routine imaging and MRI. After histological diagnosis of PM, neoadjuvant therapy was conducted, followed by partial pleurectomy or extended pleurectomy/decortication, with intraoperative biopsies of suspicious chest wall lesions. The CT/MRI results were compared to the intraoperative biopsies. Sensitivity and specificity of both modalities were analyzed. Results Twenty-five patients (mean age 65.4, 12% female) with possible chest wall infiltration were included out of the 35 patients with PM treated during the observation period. Of the 10 patients with actual chest wall infiltration, 9 (90%) had a T-Stage of 3 or higher, 9 (90%) had PM of epithelioid histologic subtype and 4 (40%) a R2-Resection. The mean overall survival of all patients was 18.88 months (8-58). In our study, thoracic MRI showed a high sensitivity (90%) and specificity (100%) for the detection of chest wall infiltration, especially when compared to the CT scan (sensitivity of 10%). Conclusion With the adjunctive use of thoracic MRI we demonstrated a higher sensitivity for detection of chest wall infiltration compared to conventional imaging prior to surgery. This may facilitate the preoperative assessment of the extent of resection. Nevertheless, larger studies are required to confirm these results.

Intraoperative Assessment of Resection Margin in Oral Cancer: The Potential Role of Spectroscopy.

In parallel with the increasing number of oncological cases, the need for faster and more efficient diagnostic tools has also appeared. Different diagnostic approaches are available, such as radiological imaging or histological staining methods, but these do not provide adequate information regarding the resection margin, intraoperatively, or are time consuming. The purpose of this review is to summarize the current knowledge on spectrometric diagnostic modalities suitable for intraoperative use, with an emphasis on their relevance in the management of oral cancer. The literature agrees on the sensitivity, specificity, and accuracy of spectrometric diagnostic modalities, but further long-term prospective, multicentric clinical studies are needed, which may standardize the intraoperative assessment of the resection margin and the use of real-time spectroscopic approaches.

OGC P05 18FDG-PET-CT is superior to CT in detecting locoregional and distant recurrence after oesophago-gastrectomy for distal oesophageal/gastro-oesophageal junctional cancer

Abstract Background Recurrent oesophageal and gastro-oesophageal junctional cancers (OGJC) are associated with poor survival. Evaluation of symptoms, monitoring of tumour markers, and spiral computed tomography (CT) can be used in postoperative surveillance to identify potential recurrence. 18FDG-PET-CT may be used when CT is equivocal despite positive clinical and biochemical markers, and may enable early diagnosis of recurrent disease. We hypothesise that 18FDG-PET-CT is superior to CT in identifying recurrent OGJC and may have a role in routine surveillance post-oesophago-gastrectomy. Methods Patients with recurrent OGJC after two-stage oesophago-gastrectomy performed in a single, tertiary, specialist UK cancer centre, who were investigated for suspected recurrence with 18FDG-PET-CT and CT within 1 month of each other, up to 5 years after primary resection were included. Demographic details including age, tumour staging (TNM classification), histological subtype, resection margin status, and serum CA19-9 and CEA levels at the time of recurrence were collected. Radiology reports were reviewed to determine whether recurrence was identified on CT, 18FDG-PET-CT or both. Statistical analyses were performed on the Datatab platform. Sensitivity of both imaging modalities at identifying recurrence was calculated. Results A total of n=65 (58 male, 7 female) patients were included. Locoregional, distant, and both locoregional and distant recurrence were identified in n=17 (26.2%), n=22 (33.8%) and n=26 (40.0%) patients respectively. 18FDG-PET-CT (63/65, 96.9% sensitivity) was superior to CT (57/63, 87.7% sensitivity) in detecting all recurrence (p=0.02) and distant recurrence (100% compared to 81.8% sensitivity). Eight patients had recurrence identified on 18FDG-PET-CT, but not by CT (n=4 distant recurrence, n=1 locoregional recurrence, n=3 distant and locoregional recurrence). Of n=5 patients who received treatment for recurrence, n=3 had single-site recurrence. Median survival following detection in this subgroup was 2 years. Conclusions This study demonstrated that 18FDG-PET-CT was significantly more sensitive than CT in detecting all recurrent OGJC, and distant recurrence. This modality may have a role in surveillance following oesophago-gastrectomy for OGJC. Its greater sensitivity may enable early diagnosis of recurrence when performed following identification of clinical or biochemical features suspicious for recurrent disease. This could enable appropriate patients to undergo further systemic anti-cancer therapy to treat recurrence, prevent further disease progression and improve survival. Further studies considering economic and logistical factors including availability of equipment to perform a higher volume of scans are required to support these findings.

Structural Damage Detection Based on Improved Sensitivity Function of Modal Flexibility and Iterative Reweighted lp Regularization

The [Formula: see text] regularization is usually used to deal with the problems of under-determinacy and measurement noise for the conventional sensitivity-based model updating damage detection methods. However, the [Formula: see text] regularization technique often provides overly smooth solutions and thus cannot exhibit the sparsity of the structural damage due to the promotion of the 2-norm term on smoothness. In the study, a structural damage detection method is proposed based on an improved modal flexibility sensitivity function and an iterative reweighted [Formula: see text] (IR[Formula: see text] regularization. Specifically, the sensitivity function is established by introducing changes in the mode shapes into the derivative of eigenvalue and can be applied to identify the localized damage more accurately. Additionally, IR[Formula: see text] regularization is proposed to deal with the ill-posed problem of damage detection in a noisy environment. The proposed IR[Formula: see text] regularization is compared with the [Formula: see text] and [Formula: see text] regularizations through a numerical and an experimental examples. The numerical and experimental results indicate that the IR[Formula: see text] regularization can more accurately locate and quantify the single and multiple damages under the noise situation. The maximum identification errors are only 5.16% and 5.67%, respectively. Moreover, compared to the basic modal flexibility sensitivity function, the improved function is more sensitive to the damage. The maximum identification error of the improved function is less than 6%, while the relative errors are significantly larger in the basic function.

Sensitivity and specificity of diagnostic modalities in pouchitis: a systematic review and meta-analysis.

Restorative proctocolectomy (RPC) is the most common surgical procedure to restore gastrointestinal continuity after surgical resection of the colon and rectum. Pouchitis is a common complication with several different modalities that can be used to aid diagnosis. This systematic review and meta-analysis aimed at exploring the sensitivity and specificity these diagnostic modalities. The medical literature was searched using MEDLINE, EMBASE and EMBASE classic and PubMed from 1978 to June 2022. We calculated descriptive statistics using sensitivity, specificity, and false-positive rate of the primary studies and also their positive and negative likelihood ratios, and their diagnostic odds ratios. The screen found 5477 records with 13 studies being included. Faecal lactoferrin was found to have the highest pooled sensitivity and specificity of 98% and 88% respectively with imaging modalities coming in second and faecal calprotectin third with pooled sensitivities and specificities of 87% and 79% and 74% and 81% respectively. Faecal biomarkers particularly lactoferrin and imaging modalities may have an important role to play in diagnosing pouchitis. Importantly due to delays in availability of pouchoscopy, our data supports early ordering of these tests to help delineate from other causes. Further studies are required with larger cohort sizes to further validate these tests.

Biliary papillomatosis.

Biliary papillomatosis (BP) is a rare disorder of the biliary tract characterized by the presence of multiple papillary adenomas spread along the biliary tree. Although benign, it carries a significant risk of malignant transformation. Due to low sensitivity and specificity of conventional radiologic modalities, the diagnosis as well as estimation of disease extent is difficult. Endoscopic ultrasound (EUS) and endoscopic retrograde cholangiopancreaticography (ERCP) are superior although direct peroral cholangioscopy (POC) is currently the most accurate diagnostic method. Mainly because it provides more detailed information and makes targeted histological diagnosis possible. The treatment of biliary papillomatosis consists of surgical resection, liver transplantation (LT) or a combination of both. Unfortunately, the recurrence rate after radical surgery without LT remains high due to the diffuse distribution of the disease.

High Altitude Cerebral Edema with concomittent rhabdomyolysis: A rare presentation

We report the case of a young gentleman who developed High Altitude Cerebral Edema (HACE) along with rhabdomyolysis whilst on a trip to the northern areas of Pakistan. High Altitude Cerebral Edema (HACE) represents a serious and potentially fatal type of Acute Mountain sickness (AMS). Rhabdomyolysis presenting with HACE is uncommon however cases have been reported. In our patient, clinical presentation with severe bilateral lower limb pain and difficulty walking along with the increased agitation and confusion made it difficult to recognize; however early descent and management allowed for good recovery. MRI findings with microhemorrhages as found in our patient are increasingly being recognized in HACE with improving sensitivity of available imaging modalities. This case highlights the diverse clinical presentations that can exist with HACE and hence the need for medical professionals to maintain a high index of suspicion in anyone with a recent ascent to high altitude regions who develop neurological manifestations.

CT scan versus Saline Load Test for Detection of Traumatic Shoulder Arthrotomy: A Cadaveric Study.

Traumatic shoulder arthrotomy (TSA) is a rare injury that is commonly detected through saline load test (SLT). There are no studies that have studied the ability of CT scan to detect a TSA. The purpose of this study is to determine the ability of CT scan to detect a TSA and compare it to the SLT. Twelve cadaveric shoulders were included in the study. Before intervention, a CT scan was conducted to determine presence of intra-articular air. After confirmation that no air was present, an arthrotomy was made at the anterior or posterior portal site. A CT was obtained post-arthrotomy to evaluate for intra-articular air. Each shoulder then underwent a SLT to assess the sensitivity of SLT and the volume needed for extravasation. Twelve shoulders were included after pre-intervention CT scan. Six shoulders received an arthrotomy through the anterior portal and six shoulders received an arthrotomy through the posterior portal. After the arthrotomy, air was visualized on CT scan in eleven of the twelve shoulders (92%). All twelve shoulders demonstrated extravasation during SLT. The mean volume of saline needed for extravasation was 29 ml with a standard deviation of 10 and range of 18 to 50ml. CT scan is a sensitive modality (sensitivity of 92%) for detection of TSA. In comparison, SLT is more sensitive (sensitivity of 100%) and outperforms CT scan for the diagnosis of TSA in a cadaveric model. Further research is needed to solidify the role that CT imaging has in the diagnosis of TSAs.