RESUMEN
OBJECTIVES: Spontaneous sternoclavicular joint infection (SSCJI) is a rare and poorly understood disease process. This study aims to identify factors guiding effective management strategies for SSCJI by using data mining. METHODS: An Institutional Review Board-approved retrospective review of patients from 2 large hospitals (2010-2022) was conducted. SSCJI is defined as a joint infection without direct trauma or radiation, direct instrumentation or contiguous spread. An interdisciplinary team consisting of thoracic surgeons, radiologists, infectious disease specialists, orthopaedic surgeons, hospital information experts and systems engineers selected relevant variables. Small set data mining algorithms, utilizing systems engineering, were employed to assess the impact of variables on patient outcomes. RESULTS: A total of 73 variables were chosen and 54 analysed against 11 different outcomes. Forty-seven patients [mean age 51 (22-82); 77% male] met criteria. Among them, 34 underwent early joint surgical resection (<14 days), 5 patients received delayed surgical intervention (>14 days) and 8 had antibiotic-only management. The antibiotic-only group had comparable outcomes. Indicators of poor outcomes were soft tissue fluid >4.5 cm, previous SSCJI, moderate/significant bony fragments, HgbA1c >13.9% and moderate/significant bony sclerosis. CONCLUSIONS: This study suggests that targeted antibiotic-only therapy should be considered initially for SSCJI cases while concurrently managing comorbidities. Patients displaying indicators of poor outcomes or no symptomatic improvement after antibiotic-only therapy should be considered for surgical joint resection.
Asunto(s)
Artritis Infecciosa , Articulación Esternoclavicular , Humanos , Masculino , Persona de Mediana Edad , Femenino , Articulación Esternoclavicular/diagnóstico por imagen , Articulación Esternoclavicular/cirugía , Artritis Infecciosa/tratamiento farmacológico , Artritis Infecciosa/cirugía , Estudios Retrospectivos , Tomografía Computarizada por Rayos X , Antibacterianos/uso terapéuticoRESUMEN
This paper presents a review of various complications of multifetal gestations identified on MR imaging and highlights findings of those complications unique to monochorionic twinning. The goal is to illustrate the potential of MR as a useful application in these clinical circumstances. A total of 32 women with multifetal gestations and suspected complication detected initially by US underwent T2-weighted MR imaging. Additional T1-weighted images were obtained when intracranial hemorrhage was suspected. MR and US findings were compared in all cases. Of 32 cases, six demonstrated fetal complications specific to monochorionic twinning; the findings consisted of conjoined twins (n=2), twin-twin transfusion syndrome (n=1), co-twin demise with embolic disease (n=2), and twin-reversed arterial perfusion. (TRAP) syndrome (n=1). MR imaging confirmed US findings in all cases and was particularly helpful in delineating the extent of intracranial complications of monochorionic twins. The technique also showed improved anatomical detail in cases of conjoined twins. MR imaging provided additional information in cases of complicated monochorionic twinning, making it a useful complementary technique when combined with initial sonographic assessment.
Asunto(s)
Imagen por Resonancia Magnética , Complicaciones del Embarazo/diagnóstico , Embarazo Múltiple , Adulto , Femenino , Muerte Fetal/diagnóstico , Transfusión Feto-Fetal/diagnóstico , Humanos , Embarazo , Resultado del Embarazo , Diagnóstico Prenatal , Gemelos Siameses , Gemelos MonocigóticosRESUMEN
OBJECTIVE: The objective of our study was to show examples of fetal MRI evaluations of congenital genitourinary anomalies and to review the embryology in relation to the MRI findings. CONCLUSION: MRI was performed on 35 pregnant women with sonographic findings that suggested that their fetuses had genitourinary anomalies. Oligohydramnios or anhydramnios was identified in 22 of 35 women and did not hinder visualization of anomalies. MRI allowed the amniotic fluid and the presence, location, and morphology of kidneys and bladder to be assessed in all fetuses at any stage of gestation and depicted sufficient anatomic detail for us to evaluate the perineum in 27 of 35 pregnancies. Therefore, we found MRI to be an excellent technique for revealing the anatomy of genitourinary anomalies in the fetus.
Asunto(s)
Imagen por Resonancia Magnética , Anomalías Urogenitales/diagnóstico , Femenino , Edad Gestacional , Humanos , Oligohidramnios/diagnóstico , Embarazo , Diagnóstico PrenatalRESUMEN
OBJECTIVE: We sought to compare the biometry of the fetal head on MR imaging with sonographic measurements in fetuses with and without suspected central nervous system abnormalities. MATERIALS AND METHODS: Blinded retrospective measurements of biparietal diameter, head circumference, and cerebellar width obtained on MR imaging were assigned a gestational age on the basis of median sonographic measurements and compared with sonographic and clinical assignment of gestational age in fetuses with no central nervous system abnormalities. In fetuses with central nervous system abnormalities, the same MR measurements were compared with sonographic measurements obtained within 1 week. Single-shot fast spin-echo sequences were obtained. Pearson's product moment correlation coefficients and paired sample t tests were performed. RESULTS: In 22 fetuses with no suspected central nervous system abnormalities, significant correlation was seen in the assignment of gestational age by MR measurements and sonographic gestational age. In 25 fetuses with central nervous system abnormalities, significant correlation was also seen between biparietal diameter and head circumference measurements. The mean biparietal diameter on MR imaging was greater than on sonography in those fetuses with central nervous system abnormalities (p = 0.038). CONCLUSION: MR imaging measurements of biparietal diameter, head circumference, and cerebellar width are strongly correlated to gestational age in fetuses without central nervous system abnormalities. Significant correlation is found between MR imaging and sonographic measurements of biparietal diameter and head circumference in fetuses with central nervous system abnormalities. Larger biparietal diameter measurements were seen with MR imaging than with sonography in the abnormal group. Fetal central nervous system biometry can be performed as part of the MR imaging evaluation of the fetal central nervous system.
Asunto(s)
Encéfalo/anomalías , Cefalometría/métodos , Enfermedades Fetales/diagnóstico , Procesamiento de Imagen Asistido por Computador/métodos , Imagen por Resonancia Magnética/métodos , Malformaciones del Sistema Nervioso/diagnóstico , Diagnóstico Prenatal/métodos , Encéfalo/patología , Femenino , Edad Gestacional , Humanos , Recién Nacido , Masculino , Embarazo , Estudios Retrospectivos , Sensibilidad y Especificidad , Ultrasonografía PrenatalRESUMEN
OBJECTIVE: The purpose of this study was to evaluate the relationship of magnetic resonance imaging and gestational age in the setting of fetuses with suspected abnormalities of the central nervous system that were detected by ultrasound scanning. STUDY DESIGN: Multiplanar magnetic resonance studies were performed in fetuses with suspected central nervous system abnormalities on ultrasound scanning. Magnetic resonance imaging was evaluated for its ability to provide additional information, change the diagnosis, or impact obstetric treatment. Patients were grouped by gestational age at the time of magnetic resonance imaging. RESULTS: Magnetic resonance imaging provided additional information in 46 of 72 pregnancies (64%), changed the diagnosis in 20 of 72 pregnancies (28%), and potentially altered the timing or mode of delivery in 8 of 72 pregnancies (11%). Additional information increased with increasing gestational age groups (P =.03). CONCLUSION: Magnetic resonance imaging provided additional information in two thirds of the fetuses with central nervous system abnormalities, which was significantly increased with increasing gestation. Antenatal treatment was influenced by magnetic resonance imaging in 11% of the cases.