Significant Additional Findings Research Articles

The Spectrum of Congenital Central Nervous System Anomalies Among Stillborn: An Autopsy Based Study

Background:Congenital central nervous system (CNS) anomalies are the structural or functional abnormalities of the brain and spinal cord that occur during the intrauterine developmental process.Purpose:The present study aims to detect the prevalence of congenital CNS anomalies among stillborn fetuses, the association between congenital anomalies and maternal factors, and also the association between autopsy and ultrasound findings.Methods:This study was conducted on 50 stillborn fetuses, obtained from the Department of Obstetrics and Gynecology at JSS Medical College and Hospital, Mysuru. The fetuses were fixed in 10% formalin and autopsies were performed as per the standard fetal autopsy protocol. The congenital CNS anomalies were studied in detail.Results:CNS anomalies were the most common congenital anomalies observed. Out of the total 50 stillborn fetuses studied, CNS anomalies were found in 17 fetuses and their occurrence was more common among male stillborn than females. Meningomyelocele was the most common anomaly, followed by anencephaly. The other anomalies documented were meningocele, encephalocele, meningoencephalocele, agenesis of the corpus callosum, craniorachischisis, bifid cerebellum with hypoplastic vermis, holoprosencephaly, and sirenomelia.Fisher’s exact test showed a significant association between maternal hypothyroidism and congenital CNS anomalies (P < .05). The autopsy confirmed the ultrasound findings in 40 (80%) fetuses. There were significant additional findings observed in seven (14%) fetal autopsies and ultrasound diagnosis completely changed in three (6%) cases, after the final autopsy procedure.Conclusion:The fetal autopsy is the single most directly evident investigation, which gives information that changes or significantly improves the clinical diagnosis. A multidisciplinary holistic approach toward pregnancy will help to detect any kind of abnormality in the fetus and thus to take a timely decision toward the management.

The added value of CT virtual angioscopy to MDCT angiography in the evaluation of aortic diseases.

Incorporation of virtual angioscopy (VA) in the diagnostic work-up of aortic diseases could improve the clinical value and efficiency of multidetector computed tomography angiography (MDCTA). We aim to evaluate the clinical usefulness of virtual aortic navigation by CT angiography in various aortic diseases as a complement to standard MDCTA. We retrospectively selected 211 patients who performed MDCTA for suspected or operated aortic diseases. VA endoluminal images of the aorta were obtained by a fly-through technique. Two senior vascular radiologists independently evaluated all MDCTA images. After 1 month, the same two radiologists independently reviewed the MDCTA images combined with CTVA images. The respective accuracy of CTVA in delineating aortic abnormalities was compared to that of MDCTA using Fisher's exact test. The Fleiss kappa (κ) statistic was used to assess the inter-reader agreement (IRA). We detected 229 abnormalities in 203 patients on MDCTA and 231 abnormalities in 205 patients on CTVA. CTVA provided significant additional findings in 63.8% (146/229) of all abnormalities diagnosed by MDCTA (p < 0.001, odd ratio [OR] = 42). Although CTVA diagnosed two abnormalities overlooked by MDCTA, the value was statistically insignificant (p = 0.787, OR = 1.3). Regarding postoperative abnormalities, the CTVA added significant additional findings over MDCTA (p = 0.006, OR = 87.4). The overall IRA for the performance of CTVA was good (κ = 0.699). CTVA yields extra findings and improves diagnostic efficiency of MDCTA, especially in postoperative patients.

Profile of Congenital Cardiovascular Anomalies among Stillborns at a Tertiary Care Hospital

Introduction: Congenital cardiovascular anomalies refer to anatomic malformation of the heart and great vessels occurring during the intrauterine developmental process. Aim: To determine the pattern of distribution of cardiovascular anomalies through autopsy and to find an association between maternal factors and congenital anomalies, and also an association between autopsy and ultrasound findings. Materials and Methods: This was a descriptive cross-sectional study, which consisted of 50 stillborn foetuses. The foetuses were obtained from the Department of Obstetrics and Gynaecology at a JSS Medical College and Hospital, Mysuru, Karnataka, India. The foetus was fixed in 10% formalin and the autopsies were carried out as per standard foetal autopsy protocol. The cardiovascular anomalies were studied in detail. Data collected were entered in MS Excel 2010 and analysed using Statistical Package for the Social Sciences (SPSS) version 22 to obtain relevant statistics. Descriptive measures like percentages were calculated and the distribution of birth weight, gestational age, maternal age, gravida of the mother, and socioeconomic status of parents among the stillborn foetuses were studied. Fisher’s-exact test was done to find out the association between maternal diabetes and cardiovascular anomalies. The results were interpreted as statistically significant at p&lt;0.05. Results: Out of the total 50 stillborn foetuses studied, cardiovascular anomalies were present in five cases. The ventricular septal defect was the most common anomaly. Other anomalies were an atrial septal defect, tetralogy of fallot, and pulmonary stenosis. The occurrence of cardiovascular anomalies was four times more common in male foetuses than in the female. Each stillborn foetus was classified, based on birth weight, gestational age, maternal age, gravidity of the mother, and socioeconomic status of parents. Maximum foetuses 29 (58%) were having a birth weight between 500-1000 grams. Maximum foetuses 20 (40%) were from the gestational age group of 22-26 weeks. The maximum number of foetuses 24 (48%) were born to mothers in the age group of 26-30 years and 22 (44%) mothers were primigravida. The maximum number of stillborns 25 (50%) belonged to the lower middle class of socioeconomic status according to Kuppuswamy’s socioeconomic scale. History of consanguinity was present in 10 (20%) mothers. Fisher’s-exact test showed a significant association between maternal diabetes and cardiovascular anomalies (p&lt;0.016). The autopsy confirmed the antenatal ultrasound findings in 40 (80%) of the cases. There were significant additional findings observed in 7 (14%) cases and ultrasound diagnosis was completely changed in 3 (6%) cases, after the final autopsy procedure. Conclusion: This study focuses on the importance of concomitant foetal autopsy in providing accurate genetic counseling. It is mandatory to have an autopsy study for all the stillborn foetuses to predict and counsel for safe future pregnancy outcomes. The preventive measures for maternal diabetes should be taken care of to avoid cardiovascular anomalies in the antenatal period and future pregnancies.

Breast cancer molecular subtype as a predictor of the utility of preoperative MRI.

The purpose of this study was to discern whether breast cancer molecular subtype, a known prognostic indicator, can be used to select patients with the highest likelihood of having clinically significant additional findings on breast MRI. A database review from January 2010 through December 2013 identified 299 patients who underwent preoperative breast MRI with tumors classifiable into molecular subtypes. Subtypes were classified on the basis of immunohistochemical staining surrogates as luminal A (hormone receptor [ER or PR] positive, ERBB2 [formerly HER2 or HER2/neu] negative, luminal B (hormone receptor positive, ERBB2 positive), ERBB2 (hormone receptor negative, ERBB2 positive), or basal (hormone receptor and ERBB2 negative). Univariate and multivariate logistic regression analyses were used to determine the association between subtype and additional breast MRI findings, including multicentric or multifocal disease, contralateral disease, chest wall involvement, skin and nipple involvement, and internal mammary and axillary lymphadenopathy. The subtype distribution was luminal A, 70.6% (211/299); luminal B, 14.1% (42/299); ERBB2, 5.4% (16/299); and basal, 10.0% (30/299). ERBB2 and luminal B sub-types were more often associated with multicentric disease (25.0% and 26.2%), multifocal disease (37.5% and 35.7%), and axillary disease (50.0% and 45.2%) than were luminal A cancers (multicentric disease, 10.9%; multifocal disease 20.4%; axillary disease, 22.7%) (p < 0.001). In multivariate analysis, after control for patient age, tumor size, and nuclear grade, patients with ERBB2-overexpressing tumors were 2.4 times as likely as patients with luminal A tumors to have multicentric disease (p = 0.016), 2.0 times as likely to have multifocal disease (p = 0.024), 1.7 times as likely to have skin and nipple involvement (p = 0.013), and 1.9 times as likely to have axillary disease (p = 0.011). Preoperative MRI may most benefit patients with tumors with ERBB2 overexpression because of the increased likelihood of the presence of additional disease.

Conservation of artists' acrylic emulsion paints: XPS, NEXAFS and ATR-FTIR studies of wet cleaning methods.

Works of art prepared with acrylic emulsion paints became commercially available in the 1960s. It is increasingly necessary to undertake and optimise cleaning and preventative conservation treatments to ensure their longevity. Model artists' acrylic paint films covered with artificial soiling were thus prepared on a canvas support and exposed to a variety of wet cleaning treatments based on aqueous or hydrocarbon solvent systems. This included some with additives such as chelating agents and/or surfactants, and microemulsion systems made specifically for conservation practice. The impact of cleaning (soiling removal) on the paint film surface was examined visually and correlated with results of attenuated total reflection Fourier transform infrared, XPS and near-edge X-ray absorption fine structure analyses – three spectroscopic techniques with increasing surface sensitivity ranging from approximately − 1000, 10 and 5 nm, respectively. Visual analysis established the relative cleaning efficacy of the wet cleaning treatments in line with previous results. X-ray spectroscopy analysis provided significant additional findings, including evidence for (i) surfactant extraction following aqueous swabbing, (ii) modifications to pigment following cleaning and (iii) cleaning system residues. © 2014 The Authors. Surface and Interface Analysis published by John Wiley & Sons, Ltd.

A comparison of non-contrast CT and intravenous urography in the diagnosis of urolithiasis and obstruction

To compare the diagnostic accuracy of non-contrast-enhanced computed tomography (NCCT) and intravenous urography (IVU) performed in the same patient in the diagnosis of urolithiasis and ureteric obstruction. This is a retrospective review of radiological and clinical data of patients with suspected urolithiasis or ureteric obstruction who had both NCCT and IVU performed within 30 days of each other. The data were analyzed using the statistical packages Epidata™ and SPSS™. The number of calculi, presence of hydronephrosis and hydroureter, cysts and ureteric wall thickening were evaluated in both NCCT and IVU. Additionally, perinephric stranding in NCCT and delayed excretion in IVU were also evaluated. Of the 139 patients (87 male and 52 female), 102 patients (73.4%) had positive findings on NCCT and 71 (51.1%) on IVU. On NCCT 133 stones were detected in 80 patients (57.6%), 67 (48.2%) in the kidney, 63 (45.2%) in the ureter and 3 (2.2%) in the bladder. The findings on NCCT were hydronephrosis in 43 (31%), hydroureter in 34 (24.5%), perinephric stranding in 7 (5%), ureteric wall thickening in 4 (2.8%), renal mass and renal cyst in 1 (0.7%) each. On IVU 86 stones were detected in 46 patients (33.1%), 53 (38.1%) in the kidney, 31 (22.3%) in the ureter and 1 (1.4%) in the bladder. The findings on IVU were hydronephrosis in 31 (22.3%), hydroureter in 18 (13%), delayed excretion in 5 (3.6%), renal cyst and ureteric wall thickening in 1 (0.7%) each. Incidental findings were more common on NCCT (23/139, 16.6%) than IVU (2/139, 1.4%). NCCT compared with IVU had a higher detection rate for ureterolithiasis, especially for stones in the distal ureter. An added benefit of NCCT was the detection of significant additional findings.

Value of Kidney-Ureter-Bladder Radiography in the Erect Position in Addition to Standard Intravenous Urography Examination

Objectives: To determine if additional kidney-ureter-bladder radiography in the erect position can improve the diagnostic yield of standard intravenous urography (IVU) examination. Subjects and Methods: This prospective study was conducted from March to July 2007 on 108 consecutive patients (65 males and 43 females, age ranging from 20 to 50 years) who were referred to the Department of Radiology, Al-Amiri Hospital, Kuwait, for IVU examinations. After 15 min, a film was done in the erect position in addition to the routine IVU protocol. Results: Additional information was demonstrated in the erect radiograph as follows: detecting nephroptosis in 18 (17%) patients, improved visualization of the ureters in 58 (54%) patients, and differentiation between phleboliths and ureteric stone was possible in 12 (11%) patients. Conclusions: Our study demonstrated significant additional findings in the erect position (at 15 min) compared to the supine position.

A Comparative Study of Prenatal Ultrasound Findings and Postmortem Examination in a Tertiary Referral Center

Most women in the United Kingdom now have prenatal screening for fetal abnormalities. This retrospective study compared the findings on prenatal ultrasound study with postmortem findings in pregnancies in which a fetal abnormality resulted in fetal loss. A total of 153 pregnancies were screened in a 12-month period and found to have such abnormalities. Autopsy findings were available in 47 cases. There were 40 terminations, 5 intrauterine fetal deaths, and 2 early neonatal deaths. The mean gestational age at the time of autopsy was 21 weeks; 72% of pregnancies were at less than 24 weeks gestation. There was no major disagreement between the ultrasound and postmortem findings in 98% of cases. Agreement was considered to be complete in 22 of these cases and major in 24. A majority of cases with complete agreement involved neurologic abnormalities. In 11 cases, there were additional but minor findings at autopsy, and in 13 cases, there were significant additional findings that added to the final diagnosis. The most common additional findings were genitourinary anomalies and dysmorphic external features. Autopsy yielded a definitive diagnosis in 13% of cases. In only 1 instance was there complete disagreement between the ultrasound and autopsy findings. This was an infant with de Lange syndrome, severely restricted growth, facial dysmorphism, cleft palate, and other abnormalities. Ultrasound study at 27 weeks gestation had shown only symmetric growth restriction and anomalies of the hands. Greater agreement between prenatal ultrasound and autopsy findings was found in this series than in previous studies. In only 1 of 47 cases was there complete disagreement. Ultrasonography is very accurate when carried out in specialist centers, but autopsies remain important for refining the diagnosis or, in some instances, making a definitive diagnosis.

Pulmonary mucormycosis: radiologic findings in 32 cases.

The purpose of this study was to characterize the radiologic manifestations of pulmonary mucormycosis with clinical and pathologic correlation. Clinical records, pathology reports, chest radiographs, and CT scans of 32 cases of pathologically proven pulmonary mucormycosis were retrospectively reviewed. The study group included 20 males and 12 females with a mean age of 47 years old. Clinical data were available for 29 patients. Signs and symptoms included fever (n = 23), cough (n = 21), bloody sputum (n = 9), dyspnea (n = 7), and chest pain (n = 6). Four patients were asymptomatic. Most patients were either immunocompromised (n = 20) or had diabetes mellitus (n = 9). Sputum or bronchoalveolar lavage cultures showed no growth in 17 of 18 cases. Diagnoses were confirmed at surgery or autopsy in all cases. Abnormalities seen on chest radiographs included lobar (n = 15) or multilobar (n = 6) consolidation, solitary (n = 7) or multiple (n = 1) masses, and solitary (n = 3) or multiple (n = 2) nodules. Cavitation was seen on chest radiographs in 13 patients, and intracavitary masses were seen in four. Associated radiographic findings included hilar (n = 3) or mediastinal (n = 3) adenopathy and unilateral (n = 6) or bilateral (n = 3) pleural effusion. CT in 19 patients revealed these significant additional findings: splenic (n = 1) or renal (n = 1) involvement, bronchial occlusion (n = 1), extrapulmonary invasion (n = 1), and pulmonary artery pseudoaneurysm (n = 1). In our study, pulmonary mucormycosis typically was manifested in immunocompromised or diabetic patients by consolidation on chest radiographs; cavitation was seen in 40% of patients. CT revealed significant unsuspected abnormalities in 26% of patients. Definitive diagnosis required pathologic demonstration of the organism in affected tissue because cultures from our patients rarely showed growth.

The value of routine proctosigmoidoscopy in hospitalized patients.

AbstractEvaluation of 1000 consecutive proctosigmoidoscopy examinations performed for the first time in patients admitted to the surgical service of the Veterans Administration Hospital of Lincoln, Nebraska, is presented. Of 143 lesions, 21 were considered malignant. Eight symptomatic patients were found with cancerous lesions. Barium enema studies did not result in significant additional findings. Comparison with results of other investigators and with programs to detect carcinoma of the cervix is made to emphasize the value of proctosigmoidoscopy in the detection of cancer of the rectosigmoid area.