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The purpose of this study was to investigate the relationship of alcohol intoxication to time-to-presentation following injury, fracture type, mechanism of injury leading to fracture, and initial diagnostic radiology interpretation performance of emergency physicians versus diagnostic radiologists in patients who present to the emergency department (ED) and are subsequently diagnosed with fracture. Medical records of 1286 patients who presented to the ED and were diagnosed with fracture who also underwent plain film or computed tomography (CT) imaging were retrospectively reviewed. The subjects were divided into intoxicated and sober groups. Patient characteristics, injury-to-presentation time, fracture location, and discrepancies between initial clinical and radiological evaluations were compared. Of 1286 subjects, 181 patients were included in the intoxicated group. Only intoxicated patients presented with head/neck fractures more than 24 hours after injury. The intoxicated group showed a higher rate of head/neck fractures (skull 23.2% vs 5.8%, face and orbit 30.4% vs 9.5%; P < 0.001) and a lower rate of extremity injuries. The rate of nondiagnosis of fractures by emergency physicians later identified by radiologists was the same in both groups (7.7% vs 7.7%, P = 0.984). While the same proportion of intoxicated patients presented more than 24 hours following injury, only intoxicated patients presented with craniofacial and cervical spinal fractures during this period. Alcohol-related injuries are more often associated with head/neck fractures but less extremity injuries. The rate of fractures missed by emergency physicians but later diagnosed by radiologists was the same in intoxicated and sober patients.

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Background: Synchronous multiple primary malignant tumors (sMPMTs) are sometimes diagnosed in patients with malignant lymphoma. We herein investigated the prognostic impact of sMPMT in lymphoma patients and the optimal treatment strategy.Methods: Seventy-five patients with sMPMTs (5.8%) among 1285 patients with lymphoma newly diagnosed between August 2004 and April 2020 were enrolled.Results: In patients with indolent lymphoma, those with sMPMTs had a worse prognosis than those without sMPMTs (5-year overall survival [OS]: 73.4% and 87.8%, respectively; P = 0.047). Among those with high and low tumor burden, the cumulative rate of death due to solid tumors was significantly higher in patients with sMPMTs than those without sMPMTs (high tumor burden: 26.7% vs. 1.6%, P < 0.001; low tumor burden: 12.7% vs. 1.0%, P = 0.003). The presence of sMPMTs did not have a significant impact on outcomes in patients with diffuse large B-cell lymphoma (DLBCL) (5-year OS: 65.4% and 66.9%, respectively; P = 0.74; 5-year progression-free survival [PFS]: 65.5% and 59.9%, respectively; P = 0.65). However, the cumulative rate of death from solid tumor in patients with sMPMTs was significantly higher than in patients without sMPMTs (5-year cumulative rate: 7.4% and 2.1%, respectively; P = 0.004). The treatment sequence did not have a significant effect on outcomes or the relative dose intensity of chemotherapy.Conclusions: In patients with indolent lymphoma, those with sMPMTs had a significantly worse prognosis than those without sMPMTs, mainly because of high mortality due to solid tumors. The presence of sMPMTs was not a significant prognostic factor in patients with DLBCL. It is important to assess the status and need for early treatment of each type of malignancy in patients with sMPMTs. [ABSTRACT FROM AUTHOR]

Background Differentiating Kawasaki disease ( KD) from cervical lymphadenitis ( CL) is clinically difficult but essential given that treatment and outcome differ significantly. Research on differentiation between KD and CL using ultrasound ( US) and computed tomography ( CT) is limited. The purpose of this study was to identify cervical US and CT findings that may differentiate KD from CL. Methods We retrospectively reviewed cervical US of 25 KD patients and 25 CL patients, and CT of 14 KD patients, and 14 CL patients. Two radiologists analyzed specific imaging features on US (lymph node size, shape, echogenicity, margins, laterality, necrosis, and presence of normal hilum) and on CT (size and location of enlarged nodes, laterality, perinodal infiltration, and retropharyngeal edema). Results On US, patients with KD more frequently had lymph nodes with a 'cluster of grapes' appearance ( KD vs CL: 64% vs 32%, P < 0.05) and less frequently had poorly circumscribed margins (0% vs 36%, P < 0.01), necrosis (0% vs 32%, P < 0.01), or non-visualization of the hilum (4% vs 36%, P < 0.01). On CT, KD patients more frequently had retropharyngeal edema (100% vs 29%, P < 0.001) and less frequently had level 4 lymphadenopathy (14% vs 79%, P < 0.01) than CL patients. Conclusions Ultrasound is mainly useful for excluding purulent lymphadenopathy while CT is a useful diagnostic tool for differentiating KD from CL, especially in patients with incomplete KD, who present with prominent cervical lymphadenopathy and other equivocal principal findings. [ABSTRACT FROM AUTHOR]

Conclusion: The pathogenesis of secondary acquired cholesteatoma with a tympanic membrane (TM) perforation is very different from that of other types of cholesteatoma. This disease should be clearly categorized as a different type of cholesteatoma. Objective: Primary cholesteatoma generally arises from retraction of the squamous epithelium of the TM. However, in rare cases, epithelial invasion occurs from the edge of the TM perforation and migrates to the medial surface of the TM and middle ear cavity. The aim of this study was to evaluate the clinical features of secondary acquired cholesteatoma with a TM perforation. Methods: We investigated 13 ears that underwent surgical treatment after the diagnosis of secondary acquired cholesteatoma with a TM perforation. Patient backgrounds, the preoperative appearances of TM, intraoperative findings, and histopathological findings were investigated. Results: The average age was much higher than that of patients with other types of cholesteatoma, suggesting that it must require long periods of time to establish the disease. The common area of the epithelial invasion was on the superior part of the TM perforation around the tip of the malleus handle. The tendon of the tensor tympani muscle plays an important role as an extension route for this disease. [ABSTRACT FROM AUTHOR]