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Renal Masses With Equivocal Enhancement at CT: Characterization With Contrast-Enhanced Ultrasound
No full textThe purpose of this article is to retrospectively investigate in two radiology centers the role of contrast-enhanced ultrasound in the characterization of renal masses with equivocal enhancement at CT (i.e., with a density increase of 10-20 HU between unenhanced and contrast-enhanced scans) not characterized with conventional ultrasound modes
Painful thoracic swelling in a refugee teenager
No full textCaseA 14-year-old refugee, escaping from a Middle East war zone, was admitted with a 3-month history of chest pain and a 2-week history of sternal swelling. The patient had no previous medical history, but reported having been beaten by a policeman at a border at the beginning of his journey. He did not have the following symptoms: cough, wheezing fever, weight loss and sweating. When he was admitted to the hospital, he was afebrile; blood pressure was 120/70 mm Hg, pulse 95 beats per minute and oxygen saturation 97% while breathing ambient air. On physical examination, there was a 10 cm fluctuating swelling in the sternal region. The lesion was reddish, warm, tender and painful (figure 1). Digital clubbing was also noticed. The remaining examination was normal. White blood cell count was 9000 cells per mm3, haemoglobin 145 g/L, erythrocyte sedimentation rate and C reactive protein were normal as well as renal and liver function tests. ECG was regular.edpract;archdischild-2020-319658v1/F1F1F1Figure 1Swelling in the sternal region. QUESTION 1: Based on the clinical picture, laboratory tests and history, what is the most likely diagnosis?Chest wall tuberculosisLymphomaThoracic actinomycosisInfected haematoma QUESTION 2: Which is the best diagnostic test to confirm this diagnosis?Ultrasound scanMRICTChest radiograph QUESTION 3: What is the mainstay of the management of this condition?Drainage of the abscessAntitubercular chemotherapyAspiration of the abscess and antitubercular chemotherapyHyperbaric oxygen therapyAnswers can be found on page 02
Carcinoma cuniculatum: usefulness of radiological assessment
No full textVerrucous carcinoma is a rarely occurring, low-grade variant of squamous cell carcinoma, slow-growing verrucous and with minimal dysplasia.[1] The incidence of epithelioma cuniculatum is unknown, with a predominance for men in their fifth–sixth decades.[2] It occurs most commonly on the ball of the sole (53%), followed by the toes (21%) and heel (16%).[3] The three major locations of verrucous carcinoma are the oral cavity (oral florid papillomatosis), the anogenital region (giant condyloma of Buschke and Lowenstein); when verrucous carcinoma involves the plantar surface of the foot, it is named carcinoma cuniculatum (CC). Metastasis from CC is rare, although it can invade deep into the soft tissues and can extend to tendons, muscles, or bone.[1,4] We report a case of a 67-year-old healthy man with 10 years history of enlarging cauliflower-like lesion of his right heel, initially diagnosed and treated as a wart. During the years, the lesion has grown progressively despite treatment until becoming a deeply penetrating mass, 6 cm × 5 cm × 3 cm, with an exophytic and hyperkeratotic component [Figure 1a]. Histopathologic examination showed hyperkeratinized epithelium, acanthosis, parakeratosis with keratin-filled cores, and crypts often contained keratin-rich neutrophil microabscesses, with a characteristic burrowing pattern; blunt papillary projections of well-differentiated epithelium, little atypia, with nonreactive edematous stroma [Figure 1e]. The histopathological diagnosis was CC. Surgical intervention is the treatment of choice for CC, with a 5-mm tumor-free margin so that early detection may result in a smaller surgical defect.[2] If the tumor causes deep bone invasion, amputation might be warranted.[2] Computed tomography (CT) is superior to any other imaging technology to assess a bone involvement, particularly when minimal changes in the cortical bone and periosteal reaction are involved, due to its excellent spatial resolution and high specificity.[4] In our patient, a solid enhancing exophytic lesion at cutaneous localization was well evident in the plantar region [Figure [Figure1c1c and andd],d], with partially deep extension in the subcutaneous adipose tissue. CT did not show any deep invasion affecting the plantar aponeurosis and calcaneus bone with an evident cleavage plane represented by adipose tissue. In the subcutaneous adipose tissue, near the lesion, there were several hyperdense strands [Figure 1c and d arrowhead], which were not infiltrative aspects of the tumor, but rather vascular structures. A wide excision and reconstruction with successful, full-thickness skin grafting were performed [Figure 1b]. After the treatment, the patient follow-up is required, as recurrence of CC has been reported despite clear histological resection margins.[3] CT is superior to magnetic resonance imaging (MRI) in determining incipient bone invasion.[4,5] MRI can discriminate better between different types of soft tissue pathology than CT, but not so precisely an early bone invasion. In other words, it delineates the depth of involvement of tumor but does not influence the final choice of surgical procedure in an early stage of invasion. CT can show early, typical signs of an aggressive tumor, as radiolucent lesions with ill-defined margins and resorption of the adjacent cortical bone.[4] Hence, it is crucial to evaluate the evidence of possible bone involvement on imaging with CT for a correct surgical approach in all CC with a high risk of bone and periosteal tissues invasion
Going Beyond Counting First Authors in Author Co-citation Analysis
Full text linkThe present study examines one of the fundamental aspects of author co-citation analysis (ACA) - the way co-citation
counts are defined. Co-citation counting provides the data on which all subsequent statistical analyses and mappings
are based, and we compare ACA results based on two different types of co-citation counting - the traditional type that
only counts the first one among a cited work's authors on the one hand and a non-traditional type that takes into
account the first 5 authors of a cited work on the other hand. Results indicate that the picture produced through this non-traditional author co-citation counting contains more coherent author groups and is therefore considerably clearer. However, this picture represents fewer specialties in the research field being studied than that produced through the traditional first-author co-citation counting when the same number of top-ranked authors is selected and analyzed. Reasons for these effects are discussed
Imaging of haemodialysis: renal and extrarenal findings
Full text linkElectrolyte alterations and extra-renal disorders are quite frequent in patients undergoing haemodialysis or peritoneal dialysis. The native kidneys may be the site of important pathologies in patients undergoing dialysis, especially in the form of acquired renal cystic disease with frequent malignant
transformation. Renal neoplasms represents an important complication of haemodialysis-associated acquired cystic kidney disease and imaging surveillance is suggested. Extra-renal complications include renal osteodistrophy, brown tumours, and thoracic and cardiovascular complications. Other important fields in which imaging techniques may provide important informations are arteriovenous fistula and graft complications
Variations on the Author
Full text link“Variations on the Author” discusses two of Eduardo Coutinho’s recent films (Um Dia na Vida, from 2010, and Últimas Conversas, posthumously released in 2015) and their contribution to the general question of documentary authorship. The director’s filmography is characterized by a consistent yet self-effacing form of authorial self-inscription: Coutinho often features as an interviewer that rather than express opinions propels discourses; an interviewer that is good at listening. This mode of self-inscription characterizes him as an author who is not expressive but who is nonetheless markedly present on the screen. In Um Dia na Vida, however, Coutinho is completely absent form the image, while Últimas Conversas, on the contrary, includes a confessional prologue that moves the director from the margins to the center of his films. This article examines the ways in which these works stand out in the filmography of a director who offers new insights into the notion of cinematic authorship
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