Severe Long-term Complication Research Articles

Sequelae of Acute Pulmonary Embolism: From Post-Pulmonary Embolism Functional Impairment to Chronic Thromboembolic Disease.

Among survivors of acute pulmonary embolism (PE), roughly half report persistent dyspnea, impaired functional status, and decreased quality of life. Post-pulmonary embolism syndrome (PPES) is a broad condition which has been increasingly recognized in recent years and may be due to post-pulmonary embolism functional impairment, chronic thromboembolic disease, or the most severe long-term complication of PE, chronic thromboembolic pulmonary hypertension. Despite guideline recommendations for appropriate follow-up for post-pulmonary embolism patients, PPES remains underrecognized and diagnostic testing underutilized. Patients with symptoms suggestive of PPES at follow-up should undergo a transthoracic echocardiogram to screen for the presence of pulmonary hypertension; additional testing, such as a ventilation/perfusion scan, right heart catheterization, and cardiopulmonary exercise testing may be indicated. The pathophysiology of post-pulmonary embolism syndrome is complex and heterogeneous. In chronic thromboembolic pulmonary hypertension, the pathophysiology reflects persistent pulmonary arterial thrombi and a progressive small vessel vasculopathy. In patients with chronic thromboembolic disease or chronic thromboembolic pulmonary hypertension, medical therapy, balloon pulmonary angioplasty, or pulmonary thromboendarterectomy should be considered, and in cases of chronic thromboembolic pulmonary hypertension, pulmonary thromboendarterectomy significantly improves mortality. In all causes of post-pulmonary embolism syndrome, rehabilitation is a safe treatment option that may improve quality of life.

6424 From Hyperparathyroidism To Neurologic Crisis: A Tale Of Brown Tumor And Spinal Cord Compression

Abstract Disclosure: A. Kormanis: None. M. Anderson: None. M. McKnight: None. H. Darapu: None. Background/Objective: In this case, we present a rare and severe consequence of secondary hyperparathyroidism, a Brown tumor leading to spinal cord compression, in a young adult with end-stage renal disease. Case Report: A 26-year-old male with a medical history of polycystic kidney disease and IgA Nephropathy complicated by ESRD, history of brown cell tumors (s/p surgery) was admitted for hospitalization due to hypocalcemia after presenting to the Emergency Department with right lower extremity weakness. Examination revealed right hip flexor weakness and right foot clonus. Lab results showed serum calcium of 10.4 mg/dL . MRI displayed a 2.5cm X 3.7 cm soft tissue mass with circumferential encroachment of the epidural space leading to severe spinal canal stenosis of T4-T5 at the site of prior Brown tumor resection. Ultimately, the patient underwent subtotal parathyroidectomy with left cervical thymectomy, leading to an intra-operative PTH drop from >3500 to 247 pg/mL. Discussion: In the context of treating vertebral brown tumors, the consensus suggests that parathyroidectomy plays a crucial role in achieving both clinical and radiographical amelioration of the tumor. However, in cases like ours where paresis is present, surgical decompression of the tumor becomes imperative. Conclusion: The development of Brown tumors is a severe and rare long-term complication for hyperparathyroidism, and the location of a Brown tumor in the thoracic spine causing symptomatic cord compression is even more rare. Presentation: 6/2/2024

Интраоперационная периферическая эндолазеркоагуляция сетчатки в профилактике неоваскулярной глаукомы

Neovascular glaucoma (NVG) is a severe long-term complication of proliferative diabetic retinopathy (PDR), including that developing in patients after vitreoretinal surgical treatment. Methods of influence aimed at breaking the cascade of biochemical processes leading to neovascularization, thereby preventing the development of NVG, are pathogenetically justified. The use of retinal laser photocoagulation (RLP) of ischemic zones and intravitreal angiogenesis inhibitors (AI) are effective. The problem of choosing a method and developing a strategy for preventing NVG is relevant. Purpose. To comparatively evaluate the effectiveness of peripheral intraoperative endolaser RLP in the prevention of NVG. Material and methods. The study included 182 patients (182 eyes) who received vitreoretinal surgical treatment for PDR complications. At baseline, all patients did not have NVG or other forms of glaucoma. Patients were divided into comparable groups depending on the type of intraoperative intervention. All patients underwent standard three-port 25 Ga vitrectomy with membrane peeling. Patients in 2nd group underwent panretinal endolaser RLP in the area from the arcades to retianl equator. Patients in 3rd group underwent peripheral endolaser RLP in the area from the retinal equator to ora serrata in combination with intravitreal injection of AI. In 1st group, endolaser RLP and AI were not used. Results. At a follow-up period of 1 month after treatment, no statistically significant differences in the incidence of rubeosis iridis were observed, and there were no cases of NVG development. At a follow-up period of 12 months after treatment in 3rd group, the development of rubeosis iridis was noted in one case and the absence of cases of NVG. In 2nd group, rubeosis iridis was detected in five patients, and NVG was detected in four patients. In 1st group, rubeosis iridis was detected in seven patients, and NVG was detected in ten patients, which is statistically significantly higher than in the other groups of the study. Conclusion. It has been established that the use of peripheral endolaser RLP in combination with intravitreal injection of AI is the most effective method for the prevention of postoperative neovascular complications in the anterior segment of the eye. Further study of the method on a representative sample of patients and in a longer postoperative period is promising. Keywords: vitreoretinal surgery, proliferative diabetic retinopathy, retinal laser photocoagulation, neovascular glaucoma, neoangiogenesis

Symptom-related screening programme for early detection of chronic thromboembolic pulmonary hypertension after acute pulmonary embolism: the SYSPPE study

BackgroundChronic thromboembolic pulmonary hypertension (CTEPH) is the most severe long-term complication of acute pulmonary embolism (PE). We aimed to evaluate the impact of a symptom screening programme to detect CTEPH...

Validación externa del algoritmo InShape II para la exclusión de la enfermedad tromboembólica crónica en los pacientes con tromboembolismo pulmonar

Background and aimThe most severe long-term complication of pulmonary embolism (PE) is chronic thromboembolic pulmonary hypertension (CTEPH), and its early diagnosis often requires numerous diagnostic tests. The InShape II study proposes an early screening algorithm that aims to reduce the number of echocardiographic studies. The objective of our study is to validate this algorithm in our patient cohort. Materials and methodsWe retrospectively analyzed patients admitted to Hospital Rey Juan Carlos between November 2017 and February 2020, who were diagnosed with PE based on computed tomography angiography (CTA). Patients were followed for at least one year, and clinical, laboratory, and complementary test data were collected at three months and one year. The InShape II algorithm was applied to these patients to validate its results. ResultsDuring the study period, 236 patients were diagnosed with PE, of which 137 were excluded. The algorithm was validated in 99 patients. Applying the InShape II score, 19 echocardiograms would have been performed (three of them with intermediate-high probability of CTEPH), while 80 echocardiograms would have been avoided (two of them with intermediate-high probability). This yielded a sensitivity of 60% and a specificity of 83% for the score, with an area under the curve (AUC) of 0.715 (95% CI: 0.472-0.958). ConclusionsOur results support the notion that the InShape II algorithm could be a useful tool for initial screening of CTEPH in low-incidence settings, as it would avoid unnecessary echocardiograms that do not provide additional value.

External validation of the InShape II study algorithm for exclusion of chronic thromboembolic pulmonary hypertension in patients with pulmonary thromboembolism

Background and aimThe most severe long-term complication of pulmonary embolism (PE) is chronic thromboembolic pulmonary hypertension (CTEPH), and its early diagnosis often requires numerous diagnostic tests. The InShape II study proposes an early screening algorithm that aims to reduce the number of echocardiographic studies. The objective of our study is to validate this algorithm in our patient cohort. Materials and methodsWe retrospectively analyzed patients admitted to Hospital Rey Juan Carlos between November 2017 and February 2020, who were diagnosed with PE based on computed tomography angiography (CTA). Patients were followed for at least one year, and clinical, laboratory, and complementary test data were collected at three months and one year. The InShape II algorithm was applied to these patients to validate its results. ResultsDuring the study period, 236 patients were diagnosed with PE, of which 137 were excluded. The algorithm was validated in 99 patients. Applying the InShape II score, 19 echocardiograms would have been performed (three of them with intermediate-high probability of CTEPH), while 80 echocardiograms would have been avoided (two of them with intermediate-high probability). This yielded a sensitivity of 60% and a specificity of 83% for the score, with an area under the curve (AUC) of 0.715 (95% CI: 0.472–0.958). ConclusionsOur results support the notion that the InShape II algorithm could be a useful tool for initial screening of CTEPH in low-incidence settings, as it would avoid unnecessary echocardiograms that do not provide additional value.

Structural brain changes in patients with post-COVID fatigue: a prospective observational study

Post-COVID syndrome is a severe long-term complication of COVID-19. Although fatigue and cognitive complaints are the most prominent symptoms, it is unclear whether they have structural correlates in the brain. We therefore explored the clinical characteristics of post-COVID fatigue, describe associated structural imaging changes, and determine what influences fatigue severity. We prospectively recruited 50 patients from neurological post-COVID outpatient clinics (age 18-69 years, 39f/8m) and matched non-COVID healthy controls between April 15 and December 31, 2021. Assessments included diffusion and volumetric MR imaging, neuropsychiatric, and cognitive testing. At 7.5 months (median, IQR 6.5-9.2) after the acute SARS-CoV-2 infection, moderate or severe fatigue was identified in 47/50 patients with post-COVID syndrome who were included in the analyses. As a clinical control group, we included 47 matched multiple sclerosis patients with fatigue. Our diffusion imaging analyses revealed aberrant fractional anisotropy of the thalamus. Diffusion markers correlated with fatigue severity, such as physical fatigue, fatigue-related impairment in everyday life (Bell score) and daytime sleepiness. Moreover, we observed shape deformations and decreased volumes of the left thalamus, putamen, and pallidum. These overlapped with the more extensive subcortical changes in MS and were associated with impaired short-term memory. While fatigue severity was not related to COVID-19 disease courses (6/47 hospitalised, 2/47 with ICU treatment), post-acute sleep quality and depressiveness emerged as associated factors and were accompanied by increased levels of anxiety and daytime sleepiness. Characteristic structural imaging changes of the thalamus and basal ganglia underlie the persistent fatigue experienced by patients with post-COVID syndrome. Evidence for pathological changes to these subcortical motor and cognitive hubs provides a key to the understanding of post-COVID fatigue and related neuropsychiatric complications. Deutsche Forschungsgemeinschaft (DFG) and German Ministry of Education and Research (BMBF).

Embolization of Recurrent Pulmonary Arteriovenous Malformations by Ethylene Vinyl Alcohol Copolymer (Onyx®) in Hereditary Hemorrhagic Telangiectasia: Safety and Efficacy.

Objectives: To evaluate short- and long-term safety and efficacy of embolization with Onyx® for recurrent pulmonary arteriovenous malformations (PAVMs) in hereditary hemorrhagic telangiectasia (HHT). Methods: In total, 45 consecutive patients (51% women, mean (SD) age 53 (18) years) with HHT referred to a reference center for treatment of recurrent PAVM were retrospectively included from April 2014 to July 2021. Inclusion criteria included evidence of PAVM recurrence on CT or angiography, embolization using Onyx® and a minimal 1-year-follow-up CT or angiography. Success was defined based on the standard of reference criteria on unenhanced CT or pulmonary angiography if a recurrence was suspected. PAVMs were analyzed in consensus by two radiologists. The absence of safety distance, as defined by a too-short distance for coil/plug deployment, i.e., between 0.5 and 1 cm, between the proximal extremity of the primary embolic material used and a healthy upstream artery branch, was reported. Results: In total, 70 PAVM were analyzed. Mean (SD) follow-up was 3 (1.3) years. Safety distance criteria were missing in 33 (47%) PAVMs. All procedures were technically successful, with a short-term occlusion rate of 100% using a mean (SD) of 0.6 (0.5) mL of Onyx®. The long-term occlusion rate was 60%. No immediate complication directly related to embolization was reported, nor was any severe long-term complication such as strokes or cerebral abscesses. Conclusions: In HHT, treatment of recurrent PAVM with Onyx® showed satisfactory safety and efficacy, with an immediate occlusion rate of 100% and a long-term rate of 60%.

Increased levels of inflammatory factors are associated with severity of polyneuropathy in type 1 diabetes.

Distal symmetrical polyneuropathy (DSPN) is a severe common long-term complication of type 1 diabetes caused by impaired sensory-motor nerve function. As chronic low-grade inflammation may be involved in the pathogenesis of DSPN, we investigated the circulating levels of inflammatory markers in individuals with type 1 diabetes with and without DSPN. Furthermore, we determined to what extent these factors correlated with different peripheral sensory nerve functions. Cross-sectional study. The study included 103 individuals with type 1 diabetes with (n=50) and without DSPN (n=53) as well as a cohort of healthy controls (n=21). Circulating levels of various inflammatory markers (cytokines, chemokines and soluble adhesion molecules) were determined in serum samples by Luminex multiplexing technology. Peripheral sensory nerve testing, for example vibration, tactile and thermal perception, was assessed by standardized procedures. The cytokines IL-1α, IL-4, IL-12p70, IL-13, IL-17A and TNF-α; the chemokine MCP-1; and the adhesion molecule E-selectin were significantly increased in individuals with type 1 diabetes with DSPN compared to those without DSPN (P<.001). These observations were independent of age, sex, BMI, disease duration and blood pressure. Additionally, higher serum concentrations of cytokines and chemokines were associated with higher vibration and tactile perception thresholds, but not with heat tolerance threshold. Individuals with type 1 diabetes and concomitant DSPN display higher serum levels of several inflammatory markers. These findings support that systemic low-grade inflammation may play a role in the pathogenesis of DSPN.

Chronic Kidney Disease After Partial Nephrectomy in Patients With Preoperative Inconspicuous Renal Function - Curiosity or Relevant Issue?

Chronic kidney disease (CKD) is a severe long-term complication after partial nephrectomy (PN). Clinical and scientific focus lies on patients with impaired renal function at the time of surgery. Little data is available on patients with normal preoperative renal function (NPRF). Patients who underwent PN with a preoperative estimated glomular filtration rate > 60 mL/min/1.73m2 were retrospectively examined at 8 European urologic centers. The occurrence of new onset CKD≥ stage III after surgery (sCKD) was defined as the primary endpoint. Group comparisons and risk correlations were determined. Based on this data, a risk stratification model for sCKD was developed. Of the 1315 patients with NPRF included, 249 (18.9%) developed sCKD after a median follow-up of 44 months (range, 6-255 months). Pair analysis and univariable regression revealed age, arterial hypertension, American Society of Anesthesiologists score, tumor stage, surgical approach, intraoperative blood loss, perioperative blood transfusions and preoperative CKD stage as predictors for sCKD development. Multivariate analysis confirmed perioperative blood transfusion (hazard ratio [HR], 2.96; P≤ .0001), age (≥ 55 years; HR, 2.60; P= .0002), tumor stage (> pT1; HR, 2.15; P= .025), and preoperative CKD stage (stage II vs. I; HR, 3.85; P≤ .0001) as independent risk factors. A model that stratified patient risk for new onset CKD was highly significant (P< .0001). Every fifth patient with NPRF developed sCKD following PN. Elderly patients with higher tumor stage and who require blood transfusion appear to be at increased risk. Based on our risk stratification, patients with≥ 2 risk factors are candidates for an early, nephrologic follow-up.

Diagnosis of chronic thromboembolic pulmonary hypertension after acute pulmonary embolism.

Chronic thromboembolic pulmonary hypertension (CTEPH) is the most severe long-term complication of acute pulmonary embolism (PE). Untreated CTEPH is fatal, but, if diagnosed in time, successful surgical (pulmonary endarterectomy), medical (pulmonary hypertension drugs) and/or interventional (balloon pulmonary angioplasty) therapies have been shown to improve clinical outcomes, especially in case of successful pulmonary endarterectomy. Early diagnosis has however been demonstrated to be challenging. Poor awareness of the disease by patients and physicians, high prevalence of the post-PE syndrome (i.e. persistent dyspnoea, functional limitations and/or decreased quality of life following an acute PE diagnosis), lack of clear guideline recommendations as well as inefficient application of diagnostic tests in clinical practice lead to a reported staggering diagnostic delay >1 year. Hence, there is a great need to improve current clinical practice and diagnose CTEPH earlier. In this review, we will focus on the clinical presentation of and risk factors for CTEPH, and provide best practices for PE follow-up programmes from expert centres, based on a clinical case.

Symptomatic osteonecrosis as a treatment complication in Hodgkin lymphoma: an analysis of the German Hodgkin Study Group (GHSG).

The majority of patients with Hodgkin Lymphoma (HL) can be cured with stage and risk adapted treatment today. Therefore, current research focuses on reducing long-term sequelae of treatment. Osteonecrosis (ON) is a severe long-term complication of HL treatment which has so far not been systematically evaluated. Hence, we investigated incidence, risk factors and timing of symptomatic ON in HL patients. Further endpoints included localization, intervention and outcome of ON. We included all qualified HL patients of the randomized German Hodgkin Study Group trials HD10-15 and HD18, recruited between 05/1998 and 07/2014 and aged from 16 to 60 years. Among 11 330 patients, 66 developed symptomatic ON after first-line treatment, 83.3% within three years. The incidence of symptomatic ON was 0.2% in early-stage HL and 1.0% in advanced-stage HL. Logistic regression revealed the total cumulative corticosteroid dose to be a strong risk factor interacting with younger age. Male sex additionally increased the risk of symptomatic ON. The prognostic value of the corresponding logistic regression model was rather high (AUC = 0.78). Other tested potential risk factors including obesity, IPS and radiotherapy did not further increase the risk of ON. Further development of current treatment protocols should aim to reduce the cumulative corticosteroid dose.

Rectal Necrosis: A Rare Complication of Palliative Radiotherapy for Sacral Spine Metastasis

Radiation proctocolitis is a common side effect of radiation therapy. In rare cases, chronic radiation injury can be severe enough to cause rectal necrosis. In this study, a case of rectal necrosis after sacral spine radiotherapy was presented. Anterior rectal wall necrosis and rectovaginal fistula is thought to be rare, severe and challenging rectal long-term complication of the previous sacral spine irradiation. Although, rectovaginal fistula which resulted in intractable rectal bleeding seems to be a rare side-effect of radiotherapy, physicians must not forget about this complication, as it can be fatal in patients who often have been cured of cancer. © 2018, Journal of Clinical and Diagnostic Research. All rights reserved.

Assessment of late cardiomyopathy by magnetic resonance imaging in patients with acute promyelocytic leukaemia treated with all-trans retinoic acid and idarubicin.

Late cardiomyopathy CMP is regarded as a potential severe long-term complication after anthracycline-based regimens for acute promyelocitic leukaemia (APL). We assess by MRI the incidence and severity of clinical and subclinical long-term CMP in a cohort of adult APL patients in first complete remission with PETHEMA trials. Adult patients diagnosed with APL in first complete remission lasting ≥2years underwent anamnesis and physical examination and were asked to perform a cardiac MRI. Clinical CMP was defined as radiographic and physical signs of heart failure accompanied by symptoms or by left ventricle ejection fraction (LVEF) <45% by MRI with or without symptoms. Subclinical CMP was defined as the following MRI abnormalities: LVEF 45-50% or late gadolinium enhancement or two or more of LVEF ≤55%, left ventricle end-diastolic volume index ≥98ml/m2, left ventricle end-systolic volume index ≥38ml/m2, right ventricle end-diastolic volume index ≥106ml/m2 and regional wall motion abnormalities. Of the 82 patients enrolled in the study, median cumulative dose of anthracyclines (doxorubicin equivalence) was 650mg/m2, and median time from APL diagnosis to the study was 87months (range, 24-195). Seven out of 57 patients with available MRI (12%) had subclinical CMP (all of them showed late gadolinium enhancement in MRI), and none had clinical CMP. Among the 25 patients without MRI, none had CMP by chest X-ray and physical assessment. In summary, we found 12% of subclinical and no clinical late CMP assessed by MRI in APL patients treated with PETHEMA protocols. Due to the low number of patients, we must interpret our results cautiously.

Long-term cognitive outcomes among unselected ventilated and non-ventilated ICU patients

BackgroundCognitive dysfunction is an important long-term complication of critical illness associated with reduced quality of life, increase in healthcare costs, and institutionalization. Delirium, an acute form of brain dysfunction that is common during critical illness has been shown to be associated with long-term cognitive dysfunction. The aim of this prospective cohort study was to estimate the prevalence and severity of cognitive dysfunction in an unselected population of medical and surgical ICU patients.MethodsThis prospective observational cohort study included all adult patients admitted to the surgical (13 beds) and medical (32 beds) ICUs of a tertiary hospital over a 12-month period. Patients with impaired cognition were excluded. At least 3 months after hospital discharge, patients were assessed for cognition using a validated battery of tests and were classified as having no cognitive impairment, mild to moderate cognitive impairment, or severe cognitive impairment.ResultsFour hundred thirteen patients were tested an average of 11 (3–18) months after discharge. Fifty-five (13.3%) patients included in the follow-up cohort had delirium. Cognitive impairment was identified in 206 (49.9%) patients, 120 (29.1%) patients had mild or moderate cognitive impairment, and 86 (20%) patients had severe cognitive dysfunction.ConclusionsThis investigation in an unselected and lower severity population of critically ill patients demonstrates that cognitive dysfunction is a frequent and severe long-term complication.

Paresis of the Peroneal Nerve: A Rare But Severe Long-term Complication of Polyethylene Wear in Knee Arthroplasty.

One of the most important limiting factors in the long-term success of total knee arthroplasty is polyethylene wear. Particles of the polyethylene inserts have been shown to elicit a foreign body response, which produces bone resorption and osteolysis, ultimately leading to loosening and component failure. The authors report on a case of an elderly patient who underwent a total knee arthroplasty almost 2 decades ago. Clinical and radiological checkups of the knee had not been performed recently. He now presented with a painful and swollen knee, recurrent joint effusion and swelling of the lower leg, and paresis of the peroneal nerve. Radiological examination showed asymmetric wear of the polyethylene insert and pronounced periprosthetic osteolysis of the proximal tibia and the distal femur. Furthermore, a large ganglion on the anterolateral aspect of the lower leg, resulting in pressure on the peroneal nerve, was detected on ultrasound examination. Open excision of the ganglion was performed initially, followed by 1-stage revision knee arthroplasty using a modular system a few weeks later. This case shows a rare but severe long-term complication of total knee arthroplasty and highlights the importance of regular clinical and radiological checkups after total joint replacements, even for asymptomatic patients and especially in the long term (ie, beyond 10 years after implantation). The current case shows that wear of the polyethylene insert may also lead to ganglion formation that causes paresis of the peroneal nerve. [Orthopedics. 2017; 40(3):e538-e540.].

Topical fluroquinolone-induced Stevens-Johnson syndrome: A case report

Stevens-Johnson syndrome (SJS) or erythema multiforme (EM) major is a complex immunological syndrome characterized by acute blistering, affecting skin and at least two mucous membranes. Toxic epidermal necrolysis (TEN) is the most severe form of EM involving skin, which sloughs in sheets. Corneal damage is the most severe long-term complication for survivors of SJS and TEN. Conjunctival inflammation is commonly encountered in Ophthalmic practice. In children, allergy and infections form the most common etiology of conjunctivitis and antibiotics are often prescribed for all conjunctival inflammations presenting with red eye. The purpose of this report is to report the rare case of SJS with topical use of fluroquinolone.

Radiation-induced lower cranial nerve palsy in patients with head and neck carcinoma.

Radiation-induced cranial nerve palsy (RICNP) is a severe long-term complication in patients with head and neck cancer following high-dose radiation therapy (RT). We present the case report of a patient with bilateral RICNP of the hypoglossal and vagus cranial nerves (XII/X) following postoperative RT in the era prior to the introduction of intensity-modulated RT (IMRT), and an analysis of our IMRT patient cohort at risk including the case of a XII RICNP. A total of 201 patients whose glosso-pharyngeal (IX), X and XII cranial nerves had been exposed to >65 Gy definitive IMRT in our institution between January, 2002 and December, 2012 with or without systemic therapy, were retrospectively identified. A total of 151 patients out of 201 fulfilling the following criteria were included in the analysis: Locoregionally controlled disease, with a follow-up (FU) of >24 months and >65 Gy exposure of the nerves of interest. So far, one of the assessed 151 IMRT patients at risk exhibited symptoms of RICNP after 6 years. The mean/median FU of the entire cohort was 71/68 months (range, 27-145). The results were compared with literature reports. In conclusion, RICNP appears to be a rare complication. However, a longer FU and a larger sample size are required to draw reliable conclusions on the incidence of RICNP in the era of IMRT.

Influence of Clinical and Radiological Variables on the Extent and Distribution of Periprosthetic Osteolysis in Total Hip Arthroplasty with a Hydroxyapatite-Coated Multiple-Hole Acetabular Component: A Magnetic Resonance Imaging Study

Polyethylene wear-induced osteolysis constitutes the most severe long-term complication of total hip arthroplasties (THA). Our aim was to assess through MRI the severity and growth pattern of osteolysis, as well as the influence clinical-radiographic variables exert. We analyzed 75 THA with an average evolution time of 13.67years. The implant was a titanium alloy, non-cemented, multiple-hole model with hydroxyapatite coating. Osteolysis was found with a peripheral pattern in 48 and a central pattern in 6; in 52 cases it was continuous, and in 4, isolated. Out of 118 screws, 20 exhibited lysis. There was a proportional correlation between osteolysis severity and wear rate with age, physical activity and acetabular abduction, as well as an association between said variables and peripheral and continuous patterns.

Incidence and clinical course of radionecrosis in children with brain tumors

Radionecrosis (RN) in children treated for brain tumors represents a potentially severe long-term complication. Its diagnosis is challenging, since magnetic resonance imaging (MRI) cannot clearly discriminate between RN and tumor recurrence. A retrospective single-center study was undertaken to describe the incidence and clinical course of RN in a cohort of 107children treated with external radiotherapy (RT) for various brain tumors between 1992 and 2012. During a median follow-up of 4.6years (range 0.29-20.1years), RN was implied by suspicious MRI findings in in 5children (4.7 %), 5-131months after RT. Suspicion was confirmed histologically (1patient) or substantiated by FDG positron-emission tomography (FDG-PET, 2patients) or by FDG-PET and MR spectroscopy (1patient). Before developing RN, all 5patients had received cytotoxic chemotherapy in addition to RT. In addition to standard treatment protocols, 2patients had received further chemotherapy for progression or relapse. Median radiation dose expressed as the biologically equivalent total dose applied in 2Gy fractions (EQD2) was 51.7Gy (range 51.0-60.0Gy). At RN onset, 4children presented with neurological symptoms. Treatment of RN included resection (n = 1), corticosteroids (n = 2) and a combination of corticosteroids, hyperbaric oxygen (HBO) and bevacizumab (n = 1). One patient with asymptomatic RN was not treated. Complete radiological regression of the lesions was observed in all patients. Clinical symptoms normalized in 3patients, whereas 2developed permanent severe neurological deficits. RN represents a severe long-term treatment complication in children with brain tumors. The spectrum of clinical presentation is wide; ranging from asymptomatic lesions to progressive neurological deterioration. FDG-PET and MR spectroscopy may be useful for distinguishing between RN and tumor recurrence. Treatment options in patients with symptomatic RN include conservative management (steroids, HBO, bevacizumab) and surgical resection.