Tomographic Evidence Research Articles

Spectral Doppler in mediastinal lymphadenopathy

Background Ultrasound is a minimally invasive diagnostic method that enables real-time sampling of the hilar and mediastinal lymph nodes. Aim To evaluate the role of spectral Doppler using endobronchial ultrasound (EBUS) in the differentiation of mediastinal lymph node lesions. Patients and methods The study was conducted at the Pulmonology Department, Faculty of Medicine, Cairo University and it was conducted between February 2023 and March 2024. The study was performed on 32 patients who had been referred to the Chest Department, Kasr El-Aini Hospital for clinical assessment; all of them have computed tomography evidence of mediastinal lymphadenopathy. All patients were subjected to history taking including age, sex, smoking, and assessment of symptoms. Clinical examination includes cervical lymph node examination, examination of neck veins and local chest examination. Computed tomography chest with i.v. contrast. Routine laboratory investigations (CBC, PT, PC, INR, liver functions, and renal functions). Ultrasound examination using spectral Doppler ultrasound and guided intervention (EBUS–TBNA) to lymph node through EBUS. Results Features of spectral Doppler using EBUS have a role in differentiating between malignant and benign mediastinal lymphadenopathy. These features include pulsatility index, resistive index, peak systolic velocity, end-diastolic velocity, lymph node texture, architecture, borders, invasion of surrounding structure and capsule, and vascularity. All are used as predictors that contribute to diagnosing malignant and benign mediastinal lymphadenopathy. Conclusion Spectral Doppler is a form of imaging using EBUS that has a role in differentiating between malignant and benign mediastinal lymphadenopathy and contributes to its diagnosis.

X-Ray Computed Tomography Evidence for Minimal Li-Metal Expansion during High-Rate Discharge in High-Energy Li|NMC811 Pouch Cells

Lithium (Li) metal batteries (LMBs) hold great promise in energy storage, offering high energy densities surpassing 350 Wh kg⁻¹ at the cell level.[1] However, their widespread adoption faces significant hurdles, including inefficient Li plating/stripping, low Coulombic efficiency, short cycle life, and dendrite formation. To address these challenges and enable the practical implementation of high-energy-density LMBs, a comprehensive understanding of degradation mechanisms affecting Li metal electrodes is crucial. Yet, the intricate degradation mechanisms of Li metal electrodes remain elusive, particularly regarding the impact of charge/discharge rates, which are essential for various practical applications. While several studies have extensively explored the influence of charging rates on LMB performance, the effect of discharging rates remains unclear.[2] Additionally, in high-energy-density cell designs, the Li metal electrode is prone to damage during disassembly, highlighting the importance of non-destructive techniques for accurate degradation assessment.This study investigates the impact of discharging rates on the degradation of Li metal electrodes in pouch-type cells with cell-level energy densities exceeding 350 Wh kg⁻¹.[3] Leveraging X-ray computed tomography (XCT) analysis as a non-destructive technique, three-dimensional structural information was obtained without sample damage. XCT analysis revealed substantial volume expansion of the Li electrode during charge/discharge cycles, especially under high-rate charging conditions. The repeated cycles induce unwanted side reactions between Li metal and the organic electrolyte, forming an electrically insulating solid-electrolyte interphase (SEI) layer on the electrode surface. Additionally, trapping of the limited amount of electrolyte (2 g Ah⁻¹) within the electrode pores exacerbates impedance growth and uneven current distribution. Interestingly, XCT observations, as shown in Figure 1, indicate suppressed volume expansion of Li during high-rate discharge, resulting in reduced impedance increase and improved cycle life. However, discharge rates beyond a threshold lead to declining capacity retention due to inefficient Li kinetics, amplifying discharge overpotential and prematurely reaching cut-off conditions. This study identifies an intermediate discharge rate offering superior cycle life, elucidating the interplay between Li electrode stability and kinetic constraints in high-energy-density LMBs under ultra-high discharge current rates. These insights hold substantial implications for advancing practical applications of high-power and high-energy LMBs.

Outcome Predictor of Spontaneous Supratentorial Intracerebral Hemorrhage Management

Background: Spontaneous intracerebral hemorrhage (SICH) is responsible for higher morbidity and mortality rates than ischemic stroke. Although SICH is less common than ischemic stroke. Identifying the predictors of outcome after spontaneous supratentorial intracerebral hemorrhage is crucial for a clinical decision-making framework and implementing efficient therapeutic measures. Aims: The study aimed to analyze the clinical profile, assess the outcome, and identify the outcome prognosticators after supratentorial SICH in the Neurosurgery Department of a tertiary care hospital in the southeastern part of Bangladesh. Materials and Methods: This prospective interventional study included 183 patients with computerized tomography (CT) evidence of supratentorial SICH above 18 years of age from the Department of Neurosurgery of Chittagong Medical College Hospital between September 2021 and February 2023.The variables analyzed were age, sex, comorbidities, Glasgow coma scale (GCS) score on admission, radiological features, treatment modality and outcome at 90-day. Glasgow outcome scale (GOS) score was used to assess the outcome. GOS score 4-5 was considered good outcome and GOS score 1-3 was considered as poor outcome. Results: The mean age of the patients was 58.9±14.4 years and 52.5% were male. The 90-day mortality rate was 50.8% and 55.2% patients had poor outcomes. On bivariate analysis, higher age, comorbid CKD state, low GCS score, higher hematoma volume, midline shift, hydrocephalus and intraventricular hematoma (IVH) were associated with poor outcome. Independent predictors of poor outcome included a higher baseline age (OR: 1.07, 95% CI:1.02-1.11, p=0.002), lower GCS on admission (OR: 0.55, 95% CI: 0.39- 0.76, p<0.001), and medical management (OR = 30.56, 95% CI = 7.15-130.69, P <0.001). Conclusions: In conclusion, SICH is associated with high mortality and morbidity. Higher age, low GCS on admission and medical management independently predicted poor outcome in the present study. Patients with a lower age, higher GCS on admission and who were managed surgically were more likely to have a good outcome. Bang. J Neurosurgery 2024; 13(2): 96-103

Interaction of accretion mechanisms and deep fluids in continental orogenesis

Interaction of accretion mechanisms and deep fluids in continental orogenesis

Stabilized Li-rich Mn-based oxide cathode particles with an artificial surface in-Situ-preprocessing

Stabilized Li-rich Mn-based oxide cathode particles with an artificial surface in-Situ-preprocessing

Dual-scale clusters enabling exceptional mechanical properties of a CoNiCr-based MP159 superalloy at 650 °C

Dual-scale clusters enabling exceptional mechanical properties of a CoNiCr-based MP159 superalloy at 650 °C

Clinical findings and outcome in goats with discospondylitis and vertebral osteomyelitis.

Vertebral infections, including vertebral osteomyelitis, septic physitis, and discospondylitis, are rarely reported in goats, and when reported, have been largely limited to necropsy case reports. Describe clinical findings and outcome in goats with vertebral infections evaluated by computed tomography (CT). Five goats with vertebral osteomyelitis, septic physitis, and discospondylitis evaluated by CT. Retrospective case series. The most common presenting complaints were progressive weakness, paresis and recumbency. Three goats were tetraparetic and 2 goats had pelvic limb paraparesis. Clinicopathologic findings included leukocytosis, mature neutrophilia, and hyperfibrinogenemia. The most common vertebrae affected were C7-T1. All 5 goats had discospondylitis with or without vertebral osteomyelitis and septic physitis. Computed tomographic evidence of spinal cord compression was present in 4/5 goats. Medical management (antimicrobials, physical therapy, analgesia, supportive care) was attempted in 4 goats, and 1 goat was euthanized at the time of diagnosis. All 4 goats that were treated regained ambulatory ability and survived to hospital discharge. Despite severity of CT imaging findings, goats with discospondylitis, septic physitis, and vertebral osteomyelitis can successfully return to ambulatory function. Additional studies are required to determine ideal treatment regimens.

Incidental osteoarthritis: risk factors, prevalence and clinical evidence in rabbits

Aim: The objective of this retrospective cohort study was to evaluate the prevalence, risk factors and level of clinically apparent disease associated with appendicular osteoarthritis in a population of rabbits under veterinary care. Method: Computed tomography reports of 311 rabbits taken for any reason over a 4-year period were evaluated for recorded evidence of appendicular osteoarthritis and the joint(s) affected. Risk factors including age, weight, body condition, breed, sex and neuter status were investigated. In rabbits with evidence of osteoarthritis, clinical notes were examined to evaluate if the condition was clinically apparent. Findings: Out of 311 computed tomography reports, 61 described evidence of osteoarthritis (19.6%). The most common joints affected were the elbow and stifle. No significant relationship between sex, body condition and neuter status in males and presence of osteoarthritis was found. A statistically significant relationship between greater age, greater weight and neuter status in females and the presence of osteoarthritis was found. Only 9 out of 61 (14.8%) of the rabbits with computed tomography evidence of osteoarthritis had clinical signs of osteoarthritis recorded in the clinical notes. Conclusions: Following the results of this study, it may be concluded that greater age and weight, as well as female neuter status, are related to increased risk of appendicular osteoarthritis in rabbits, but changes on imaging may relate poorly to clinically apparent disease.

CHARACTERISTICS, OUTCOMES, AND OPTICAL COHERENCE TOMOGRAPHY FEATURES OF MACULAR HOLE AFTER RHEGMATOGENOUS RETINAL DETACHMENT REPAIR.

To investigate full-thickness macular holes (FTMHs) that develop after rhegmatogenous retinal detachment (RRD) repair. Retrospective consecutive case series of patients who underwent RRD repair between 2015 and 2021 and subsequently developed FTMH. Twenty-three patients (23 eyes) were included. All eyes underwent pars plana vitrectomy + membrane peel for macular hole (MH) repair. The mean age at RRD diagnosis was 62 years and 52% were male. In total, 78% were macula-off RRDs. Fourteen eyes (60.9%) underwent pars plana vitrectomy alone, 7 (30.4%) underwent pars plana vitrectomy and scleral buckling, 1 (4.3%) underwent scleral buckling only, and 1 (4.3%) underwent pneumatic retinopexy. Median time from RRD repair to MH diagnosis was 116 days. Macula-off RRDs had a significantly lower time to MH diagnosis (mean 154 days, P < 0.05) than macula-on RRDs (mean 875 days). Twenty-one MH (91%) had optical coherence tomography evidence of an epiretinal membrane. Mean logMAR visual acuity at MH diagnosis was 1.05 (∼20/224) and significantly improved to 0.66 (∼20/91) at the final follow-up ( P < 0.001); 100% of MHs closed by the final follow-up. Pars plana vitrectomy for MH after RRD repair has a high closure rate and leads to significant VA improvement. MH formation after RRD repair may be associated with macula-off detachments and epiretinal membrane. Macula-off RRDs develop MH faster than macula-on RRDs.

Cluster Analysis of World Trade Center Related Lower Airway Diseases.

Introduction: Cluster analysis can classify without a priori assumptions the heterogeneous chronic lower airway diseases found in former workers at the World Trade Center (WTC) disaster site. Methods: We selected the first available chest computed tomography scan with quantitative computed tomography measurements on 311 former WTC workers with complete clinical, and spirometric data from their closest surveillance visit. We performed a nonhierarchical iterative algorithm K-prototype cluster analysis, using gap measure. Results: A five-cluster solution was most satisfactory. Cluster 5 had the healthiest individuals. In cluster 4, smoking was most prevalent and intense but there was scant evidence of respiratory disease. Cluster 3 had symptomatic subjects with reduced forced vital capacity impairment (low FVC). Clusters 1 and 2 had less dyspneic subjects, but more functional and quantitative computed tomography evidence of chronic obstructive pulmonary disease (COPD) in cluster 1, or low FVC in cluster 2. Clusters 1 and 4 had the highest proportion of rapid first-second forced expiratory volume decliners. Conclusions: Cluster analysis confirms low FVC and COPD/pre-COPD as distinctive chronic lower airway disease phenotypes on long-term surveillance of the WTC workers.

Formation conditions of the young flat-slab in the wedge subduction zone

Formation conditions of the young flat-slab in the wedge subduction zone

Clinical and Optical Coherence Tomography Evidence of Aqueous Humor Flow from the Suprachoroidal Space to Conjunctival Lymphatics.

A surgical technique was developed to enhance aqueous humor (AH) flow through the non-trabecular outflow pathway by rerouting it from the anterior chamber (AC) to the suprachoroidal space (SCS) without detaching the ciliary body from the scleral spur. Medium- and long-term surgical outcomes were retrospectively analyzed in a case series of 58 glaucoma patients. At 6, 12, and 24 months, the mean IOP decreased from 27.8 ± 8.3 to 14.9 ± 5.0 mmHg, median 15.0 (25th percentile (p25)13.0; 75th percentile (p75) 18.0) and 15.2 ± 3.3 mmHg, and hypotensive medication use reduced from a median (p25; p75) of 3 (2; 3) to 0 (0; 2), 0 (0; 2), and 0 (0; 1.5), respectively. Intra- and postoperative complications were few and manageable. Following surgery, no bleb formation occurred in any of the cases (as confirmed by optical coherence tomography). Conjunctival lymphatic vessels (CLVs) developed in 50% of eyes (29/58). Clinically, they developed directly from sclera and had no connection to the surgical site. Analysis further showed that the development of CLVs and their longer visibility period had poor prognostic value for IOP control. If the fluid flow from the SCS to CLVs was resistance-free, no CLV development was evident. However, if any resistance existed in the flow, the fluid accumulated in lymphatics, resulting in their engorgement. The proposed technique was safe and effective in decreasing IOP in glaucoma patients by enhancing AH flow from the SCS to CLVs via connecting intrascleral microchannels.

A case of bacteremia and pneumonia caused by Streptococcus equi subspecies equi infection in a 70-year-old female following horse exposure in rural Wyoming

BackgroundThe occurrence of zoonotic infections following an animal exposure continues to be an important consideration for all patients, especially those within agricultural communities. Streptococcus equi subspecies equi (S. equi subsp. equi) is a bacteria known to cause a common infection called ‘Strangles’ in horses. This article highlights a new case of pneumonia and bacteremia in a patient caused by S. equi subsp. equi following strangles exposure in a horse. Rarely has there been reported horse to human transmission of subsp. equi.Case PresentationA 70-year-old woman attended a rural emergency department with complaints of dry heaving, fever, chills, shakes, and nausea and presented with a cough. She had undergone a screening colonoscopy two days prior with no other significant medical history. The patient had computed tomography (CT) evidence of a pneumonia and positive blood cultures growing S. equi subsp. equi consistent with bacteremia. The patient later disclosed the recent passing of her horse following its sudden illness six days prior to her emergency department presentation. She had cuddled and kissed the horse prior to its death. The patient was treated with IV lactated ringers during the initial evaluation and admission and also received IV piperacillin-tazobactam 4.5 g every eight hours intravenously during her hospital stay. She was transitioned to an oral antibiotic on discharge. Subsequent blood cultures drawn the day after discharge were negative for S. equi subsp. equi, indicating successful treatment of her bacteremia.ConclusionsThis report discusses an atypical presentation of S. equi subsp. equi infection in an otherwise healthy individual, manifesting as early sepsis, pneumonia, and bacteremia. The patient likely developed this infection following direct contact exposure to her horse who had died from presumed strangles a few days prior to her symptom onset. This case highlights the importance of investigating potential exposures to S. equi subsp. equi in rural areas, areas where farming and ranching are prevalent, particularly among individuals working with horses. It is especially important to acknowledge high risk populations such as immunocompromised individuals with signs and symptoms of meningitis or bacteremia.

Canal narrowing in adult patients with cervical spinal cord injury without computed tomography evidence of trauma

Cervical spinal cord injury can be a particularly devastating sequela of trauma. The purpose of this study was to describe the imaging findings of adult patients with cervical spinal cord injury without computed tomography evidence of trauma (SCIWOCTET). All adult patients (≥18years) treated for acute cervical SCIWOCTET at a single Level I adult trauma center over an eight-year period were retrospectively identified. CT imaging was evaluated for degenerative changes narrowing the midsagittal canal diameter (SCD) of the cervical spine and relative congenital cervical stenosis (CCS; congenital narrowing of the SCD <13mm). Magnetic resonance imaging (MRI) scans were evaluated for signal intensity change (SIC) suspicious for cord edema/contusion as well as ligamentous injury, hemorrhage, and epidural hematoma. Ninety-six patients with cervical SCIWOCTET met inclusion criteria. The most common mechanism of injury was fall from standing (47.9%). On CT, 86 patients (89.6%) had CCS. Degenerative changes were present in 95 patients (99.0%). In 98/99 patients (99.0%), the point of narrowest cervical SCD was ≤8mm. On MRI, 79 patients (82.3%) demonstrated signal intensity change (SIC) indicative of cord edema/contusion, while 16 (16.7%) had ligamentous injury. Intramedullary cord hemorrhage was seen in two patients (2.1%) and epidural hematoma in three (3.1%). Degenerative changes or CCS may narrow the minimum cervical SCD beyond the threshold at which low-energy trauma results in C-SCI. Adult patients with cervical spinal stenosis, whether congenital and/or degenerative, and neurologic findings referable to the cervical spine should be assessed for C-SCI.

Intravascular ultrasound imaging in evaluation of aortic stiffness: A proof-of-concept study.

Aortic stiffness is a well-known cardio-vascular risk factor. For years, different methods have been studied in the assessment of aortic elastic properties and large arterial stiffness for risk stratification. Herein is an assessment of the role of intravascular ultrasound (IVUS) imaging for the evaluation of aortic elastic properties. Intravascular ultrasound imaging of the aorta was performed in 12 patients with transthoracic echocardiography (TTE) and computed tomography (CT) evidence for enlargement of the ascending aorta - diameter ≥ 40.0 mm. Mechanical properties of the aorta were derived from the measured diameters and intra-aortic pressure. Paired samples T-test analyses were performed to determine differences between measurements derived by TTE, CT and IVUS. Mean values of the calculated elastic properties via IVUS of the ascending aorta were as follows: compliance 0.021 ± 0.02; strain 205 ± 4.3; aortic stiffness index 4.3 ± 0.75; elastic modulus 0.31 ± 0.05. On paired T-test analysis maximum ascending aortic diameter measured by CT aortography and IVUS did not differ significantly (t = -0.19, p = 0.985), but a significant difference between IVUS measurements and TTE derived diameters was found (t = 13.118, p = 0.034). On average, IVUS diameters were 2.3 mm larger than the results acquired by TTE (95% confidence interval: 14.21-17.13). Intravascular ultrasound examination of the ascending aorta provided larger diameters than the ones collected by means of TTE. However, IVUS measurements did not differ significantly from diameters derived by CT aortography.

A storm or a storm in a teacup? A retrospective review of spontaneous pneumomediastinum at a tertiary Australian Hospital

Background: Spontaneous pneumomediastinum (SP) is defined as the presence of free air in the mediastinum without a clear precipitating cause. Whilst uncommon and with a relatively benign course, SP is often thoroughly investigated by surgeons as spontaneous oesophageal perforation (Boerhaave’s syndrome) must be identified early due to high morbidity and mortality. This study aimed to evaluate current practice in the investigation and management of SP at our institution. Methods: All patients with imaging-confirmed pneumomediastinum at a tertiary hospital from 2014 to 2022 were reviewed. Those with precipitating trauma, recent surgery or aerodigestive instrumentation were excluded. Results: 70 patients were included; 4 (5.7%) patients were diagnosed with Boerhaave’s syndrome based on computed tomography (CT) evidence of oesophageal injury alone and were treated with immediate surgery. The remaining 66 patients were diagnosed with SP. In this group, common predisposing factors were young age, smoking, illicit drugs and alcohol. The lead presenting symptoms were dyspnoea, chest pain, vomiting and cough. Of the 13 different admitting specialties, respiratory and upper gastrointestinal surgery were most common. Of those patients diagnosed with SP, 37 (54%) patients underwent imaging to exclude oesophageal injury; 30 (43%) were assessed using CT with oral contrast, 16 (23%) had a fluoroscopic contrast oesophagram, and 9 were investigated with both modalities. Conclusions: SP is uncommon, benign and does not require operative intervention. Multiple specialities manage SP at our institution and the use of imaging modalities differs between teams. We propose a management algorithm to assist clinicians unfamiliar with SP, risk-stratify patients for oesophageal injury and avoid unnecessary investigation.

18F]FDG PET/CT: Lung Nodule Evaluation in Patients Affected by Renal Cell Carcinoma.

Renal Cell Carcinoma (RCC) is generally characterized by low-FDG avidity, and [18F]FDG-PET/CT is not recommended to stage the primary tumor. However, its role to assess metastases is still unclear. The aim of this study was to evaluate the diagnostic accuracy of [18F]FDG-PET/CT in correctly identifying RCC lung metastases using histology as the standard of truth. The records of 350 patients affected by RCC were retrospectively analyzed. The inclusion criteria were: (a) biopsy- or histologically proven RCC; (b) Computed Tomography (CT) evidence of at least one lung nodule; (c) [18F]FDG-PET/CT performed prior to lung surgery; (d) lung surgery with histological analysis of surgical specimens; (e) complete follow-up available. A per-lesion analysis was performed, and diagnostic accuracy was reported as sensitivity and specificity, using histology as the standard of truth. [18F]FDG-PET/CT semiquantitative parameters (Standardized Uptake Value [SUVmax], Metabolic Tumor Volume [MTV] and Total Lesion Glycolysis [TLG]) were collected for each lesion. Sixty-seven patients with a total of 107 lesions were included: lung metastases from RCC were detected in 57 cases (53.3%), while 50 lesions (46.7%) were related to other lung malignancies. Applying a cut-off of SUVmax ≥ 2, the sensitivity and the specificity of [18F]FDG-PET/CT in detecting RCC lung metastases were 33.3% (95% CI: 21.4-47.1%) and 26% (95%CI: 14.6-40.3%), respectively. Although the analysis demonstrated a suboptimal diagnostic accuracy of [18F]FDG-PET/CT in discriminating between lung metastases from RCC and other malignancies, a semiquantitative analysis that also includes volumetric parameters (MTV and TLG) could support the correct interpretation of [18F]FDG-PET/CT images.

Endoscopic Ultrasound Predicts Risk of Occult Intra-Abdominal Metastases in Localized Gastric Cancer: A Validation Study.

In gastric cancer (GC) patients without imaging evidence of distant metastasis, diagnostic staging laparoscopy (DSL) is recommended to detect radiographically occult peritoneal metastasis (M1). DSL carries a risk for morbidity and its cost-effectiveness is unclear. Use of endoscopic ultrasound (EUS) to improve patient selection for DSL has been proposed but not validated. We aimed to validate an EUS-based risk classification system predicting risk for M1 disease. We retrospectively identified all GC patients without positron emission tomography (PET)/computed tomography (CT) evidence of distant metastasis who underwent staging EUS followed by DSL between 2010 and 2020. T1-2, N0 disease was EUS "low-risk"; T3-4 and/or N+ disease was "high-risk". A total of 68 patients met inclusion criteria. DSL identified radiographically occult M1 disease in 17 patients (25%). Most patients had EUS T3 tumors (n = 59, 87%) and 48 (71%) patients were node-positive (N+). Five (7%) patients were classified EUS "low-risk" and 63 (93%) were classified "high-risk". Of 63 "high-risk" patients, 17 (27%) had M1 disease. The ability of "low-risk" EUS to predict M0 disease at laparoscopy was 100% and DSL would have been avoided in five patients (7%). This stratification algorithm showed a sensitivity of 100% (95% confidence interval (CI): 80.5-100%) and a specificity of 9.8% (95% CI: 3.3-21.4%). Use of an EUS-based risk classification system in GC patients without imaging evidence of metastasis helps identify a subset of patients at low-risk for laparoscopic M1 disease who may avoid DSL and proceed directly to neoadjuvant chemotherapy or resection with curative intent. Larger, prospective studies are needed to validate these findings.

The prevalence of headshaking in horses with primary and secondary dental sinusitis and computed tomographic evidence of infraorbital canal pathology.

Sinusitis is a common disease of horses yet there are a limited number of reports in the literature that describe the prevalence of infraorbital canal (IOC) pathology and headshaking behaviour in horses diagnosed specifically with primary sinusitis and secondary dental sinusitis. Given the impact that these behaviours can have on horses' intended athletic use, investigation is warranted. To determine the occurrence of IOC pathology in horses with concurrent primary or secondary dental sinusitis based on computed tomography (CT) findings and to assess whether the frequency of headshaking behaviour is influenced by the presence of IOC pathology. Retrospective case series. Computed tomography studies were assessed for sinusitis (unilateral or bilateral), IOC pathology (unilateral or bilateral) and description of IOC disease including displacement, deformation, periosteal proliferation, hyperostosis, osteolysis and infraorbital nerve exposure. Behaviour outcome was determined by client questionnaire five or more years following CT scan. A total 65 out of 66 horses diagnosed with primary or secondary dental sinusitis demonstrated IOC changes on CT. Hyperostosis (86%), periosteal proliferation (85%) and osteolysis (86%) were common CT findings. Hyperostosis was frequently found to involve both the IOC and supporting bone structure. Five cases were euthanized immediately after CT acquisition or during hospitalisation following diagnostic investigations. Follow-up was obtained in 48/61 cases, with five horses showing headshaking behaviour. Infraorbital nerve histopathology was not performed. The limited number of cases with no IOC pathology prevented direct comparison between sinusitis groups both with IOC pathology and without IOC changes. The client questionnaire carries a memory bias. Computed tomography changes involving the IOC may not predict headshaking behaviours in sinusitis secondary to dental disease. This finding is important in the context that these behaviours render some horses unusable and unsafe for their intended riding discipline.

Early Enteral Feeding in Severe Acute Pancreatitis: A Randomized Clinical Trial Between Gastric vs Distal Jejunal Feeding

Early Enteral Feeding in Severe Acute Pancreatitis: A Randomized Clinical Trial Between Gastric vs Distal Jejunal Feeding