Search

Training healthcare physicians to perform intestinal ultrasound (IUS) during outpatient visits with equal accuracy as radiologists could improve clinical management of IBD patients. We aimed to assess whether a healthcare-physician can be trained to perform IUS, with equal accuracy compared with experienced radiologists in children with iBD, and to assess inter-observer agreement.Consecutive children, 6 to 18 years with IBD or suspicion of IBD, who underwent ileo-colonoscopy were enrolled. iUS was performed independently by a trained healthcare-physician and a radiologist in 1 visit. Training existed of an international training curriculum for IUS. Operators were blinded for each other's IUS, and for the ileocolonoscopy. Difference in accuracy of IUS by the healthcare-physician and radiologist was assessed using areas under the ROC curve (AUROC). Inter-observer variability was assessed in terminal ileum (TI), transverse colon (TC) and descending-colon (DC), for disease activity (ie, bowel wall thickness [BWT]2 mm with hyperaemia or fat-proliferation, or BWT3 mm).We included 73 patients (median age 15, interquartile range [IQR]:13-17, 37 [51%] female, 43 [58%] with Crohn disease). AUROC ranged between 0.71 and 0.81 for the healthcare-physician and between 0.67 and 0.79 for radiologist (P 0.05). Inter-observer agreement for disease activity per segment was moderate (K: 0.58 [SE: 0.09], 0.49 [SE: 0.12], 0.52 [SE: 0.11] respectively for TI, TC, and DC).A healthcare- physician can be trained to perform IUS in children with IBD with comparable diagnostic accuracy as experienced radiologists. The interobserver agreement is moderate. Our findings support the usage of IUS in clinical management of children with IBD.

Subcutaneous fat necrosis of the newborn with follow-up of the hypercalcemia A thirteen-day-old boy is diagnosed with subcutaneous fat necrosis of the newborn after the appearance of erythematous, subcutaneous plaques on the right shoulder. This rare, usually self-limiting cutaneous disease is mainly diagnosed in term and postterm infants. The diagnosis is confirmed by a skin biopsy. Various etiological hypotheses are suggested, although the exact pathogenesis needs to be elucidated. The disease might be associated with several maternal and foetal predisposing factors, including therapeutic hypothermia at birth as part of hypoxic ischemic encephalopathy. It is a benign inflammation of the subcutaneous adipocytes that can be accompanied by life-threatening complications, such as hypercalcemia and thrombocytopenia. The latter requires rigorous follow-up and, in some cases, also treatment. The skin damage should only be treated symptomatically with analgesia.

Background. Thyroid storm is a well-known complication of surgical procedures in the lower neck, but is rare after a blunt neck trauma. The cases described previously have mainly focussed on adults with pre-existent thyroid disease. In this case report, we describe the disease course of a previously healthy adolescent who had asymptomatic hyperthyroxinemia after a blunt trauma of the jaw and neck. Case Presentation. A 17-year-old girl presented at our emergency department after she fell on her head while roller blading. On physical examination, among other injuries, she had a swelling in the lower neck, which appeared to involve the thyroid gland. Subsequent laboratory analysis was indicative of primary hyperthyroxinemia, with a free T4 of 59 pmol/L (reference range: 12–22) and a TSH of 0.46 mU/L (reference range: 0.5–4.3), but the patient had no symptoms fitting with this. Four weeks after the initial presentation, the patient reported only complaints regarding tenderness in the jaw and neck region. She was no longer hyperthyroidic on biochemical evaluation (with a free T4 level of 15.6 pmol/L and a TSH level of 0.33 mU/L), and antibodies against thyroid peroxidase or TSH receptor were not present. Conclusions. This case might indicate that hyperthyroxinemia following a neck trauma may go unnoticed if hyperthyroid symptoms are mild or absent and thyroid function tests are not performed.

Objective To assess the additional value of fetal multiplanar (axial, coronal and sagittal) neurosonography and magnetic resonance imaging (MRI) to that of the standard axial ultrasound planes in diagnosing brain damage in fetuses at high risk.Methods This was a prospective, multicenter, observational study. Women were eligible for participation if their fetus was at risk for acquired brain anomalies. Risk factors were congenital infection, alloimmune thrombocytopenia, fetal growth restriction, trauma during pregnancy, fetal hydrops, monochorionic twins and prior ultrasound finding suggestive of an acquired brain anomaly. Examinations of the fetal brain before birth comprised axial ultrasound and advanced neurosonography biweekly and MRI once. After birth, neonatal cranial ultrasound was performed at 1SD below the mean were considered suspicious for neurodevelopmental sequelae.Results Fifty-six fetuses were examined, and in 39/56 fetuses, all fetal-imaging modalities were available. PVE/SI changes were observed in 6/39, 21/39 and 2/39 fetuses on axial ultrasound planes, multiplanar neurosonography and MRI, respectively. IVH was found in 3/39, 11/39 and 1/39 fetuses, and BGTE/SI changes in 0/39, 12/39 and 0/39 fetuses, respectively. Outcome was suspicious for neurodevelopmental sequelae in 13/46 infants at 1 year, and at 2 years, 41/41 children had scores within 1 SD of the mean on BSID-III and 20 had scores > 1 SD below the mean on the behavioral (5/38), sensory profile (17/37) and/or linguistic (6/39) questionnaires.Conclusions In this cohort of fetuses at risk for brain damage, the severity of acquired brain anomalies was limited. Nevertheless, multiplanar neurosonography detected more fetal PVE changes, IVH and/or BGTE changes compared to the standard axial ultrasound planes and MRI. Fetal MRI did not demonstrate any anomalies that were not seen on neurosonography. Neurodevelopmental outcome at 2 years of age showed no or mild impairment in most cases. (C) 2019 The Authors. Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of the International Society of Ultrasound in Obstetrics and Gynecology.

Cold snare polypectomy (CSP) is an accepted technique to remove diminutive or small (6-9 mm) polyps. Here we present a series of CSP for advanced non-pedunculated polyps (10 mm).This is a retrospective, single operator study. A total of 111 patients with non-pedunculated polyps (Paris classification 0-IIa, 0-IIb, 0-Is) estimated10 mm, underwent CSP.A total of 129 polyps were removed (87 0-IIa, 18 0-IIb, 24 0-Is). The number of these polyps ranked according to size were as follows : 11-19 mm : 63 (49%), 20-29 mm : 44 (34%),30 mm : 22 (17%). Thirty-eight (29.5%) were sessile serrated adenomas, 47 (36%) were tubular adenomas, 25 (19.3%) were villous adenoma's and 18 (14%) were hyperplastic polyps. Forty-nine (38%) polyps were resected in a piecemeal fashion, submucosal injection with diluted Indigo Carmine was used in 24 (19%). Immediate oozing bleeding was frequent but in almost all patients rapid spontaneous haemostasis occurred. In only one patient haemostatic clipping was required (in order to achieve hemostasis). Preventive clipping was used in 3 patients. There were no complications. Seventy-two patients (with 87 lesions) had a follow-up colonoscopy. Of these 87 lesions, 9 had residual adenomatous tissue (10.3 %). According to the size of the original polyp, the distribution was as follows: 11-19 mm : 2/36 (5.5 %), 20-29 mm : 4/32 (12.5 %),30 mm : 3/19 (15.7%).CSP for advanced, non-pedunculated lesions is feasible, effective and extremely safe.

International audience; The aim of this study was to assess the influence of a recent conversion to organic farming on the physical properties, particularly the aggregate stability, of soils that are prone to soil crusting, as well as their impact on runoff, soil erosion and soil crusting dynamics. Experiments were conducted in the area of Brie, France, in two agricultural fields separated by 400 m with similar slopes and soil types. They consisted of physical measurements of the soils as well as simulated rainfalls with different intensities. No significant differences were detected among the bulk density, soil water retention or saturated hydraulic conductivity. The aggregate stability, measured both under simulated rainfall and in a laboratory, was significantly higher in the organic management field (OF) than in the conventional management field (CM), indicating that CM soils are more prone to soil crusting than OF soils. The influence of this difference was quantified using rainfall simulations in the field. Within the CM field, runoff occurred with a runoff coefficient (RC) of 4.8% and 6.9% when the rainfall intensities were 25 and 40 mm h−1, respectively, while in the OF field, no runoff was observed at these intensities. However, slight runoff was observed when the intensity was 50 mm h−1. Soil losses followed the same trend. Depositional soil crusts were observed in the plots wherein runoff transpired. These results evidence the benefits of recent conversion to organic farming in silty soil to the aggregate stability and consequently soil crust dynamics, runoff genesis and soil erosion.

Objectives The incidence of children developing metachronous contralateral inguinal hernia (MCIH) is 7–15%. Contralateral groin exploration during unilateral hernia repair can prevent MCIH development and subsequent second surgery and anaesthesia. Preoperative ultrasonography is a less invasive strategy and potentially able to detect contralateral patent processus vaginalis (CPPV) prior to MCIH development. Methods We queried MEDLINE, Embase and Cochrane library to identify studies regarding children aged < 18 years diagnosed with unilateral inguinal hernia without clinical signs of contralateral hernia, who underwent preoperative ultrasonography of the contralateral groin. We assessed heterogeneity and used a random-effects model to obtain pooled estimates of sensitivity, specificity and area under the receiver operating characteristic curve (AUC). Results Fourteen studies (2120 patients) were included, seven (1013 patients) in the meta-analysis. In studies using surgical exploration as reference test (n = 4, 494 patients), pooled sensitivity and specificity were 93% and 88% respectively. In studies using contralateral exploration as reference test following positive and clinical follow-up after negative ultrasonographic test results (n = 3, 519 patients), pooled sensitivity was 86% and specificity 98%. The AUC (0.984) shows high diagnostic accuracy of preoperative ultrasonography for detecting CPPV, although diagnostic ultrasonographic criteria largely differ and large heterogeneity exists. Reported inguinal canal diameters in children with CPPV were 2.70 ± 1.17 mm, 6.8 ± 1.3 mm and 9.0 ± 1.9 mm. Conclusion Diagnostic accuracy of preoperative ultrasonography to detect CPPV seems promising, though may result in an overestimation of MCIH prevalence, since CPPV does not invariably lead to MCIH. Unequivocal ultrasonographic criteria are mandatory for proper diagnosis of CPPV and subsequent prediction of MCIH. Key Points • Diagnostic accuracy of preoperative ultrasonography for detection of CPPV in children with unilateral inguinal hernia is high. • Preoperative ultrasonographic evaluation of the contralateral groin assumedly results in an overestimation of MCIH prevalence. • Unequivocal ultrasonographic criteria are mandatory for proper diagnosis of CPPV and risk factor identification is needed to predict whether CPPV develops into clinically apparent MCIH. Electronic supplementary material The online version of this article (10.1007/s00330-018-5625-6) contains supplementary material, which is available to authorized users.

Aim: To determine acceptance of pregnant women to undergo fetal magnetic resonance imaging (MRI) examination in research and clinical setting. Methods: A prospective study included a research group [part of a study comparing brain ultrasound (US) to MRI in fetuses at risk for acquired brain damage] and a clinical group [fetuses with suspected (brain) anomalies after structural US examination] from 2011 to 2014. All women were advised to use sedatives. MRI declinations, use of sedation, MRI duration and imaging quality were compared between both groups. Results: Study participation was accepted in 57/104 (55%) research cases. Fetal MRI was performed in 34/104 (33%) research and 43/44 (98%) clinical cases. Reasons to decline study participation were MRI related in 41%, and participation was too burdensome in 46%. Acceptance was highest for indication infection and lowest in alloimmune thrombocytopenia and monochorionic twin pregnancy. Sedatives were used in 14/34 research and 43/43 clinical cases. Scan duration and quality were comparable (21 and 20 min in research and clinical cases, respectively, moderate/good quality in both groups). Conclusions: Pregnant women consider MRI more burdensome than professionals realize. Two-third of women at risk for fetal brain damage decline MRI examination. Future studies should evaluate which information about fetal MRI is supportive.

Tijdens magnetisch resonantie-onderzoek (MRI) hebben jonge kinderen en kinderen met een vertraagde ontwikkeling een vorm van procedurele sedatie (PS) nodig om voldoende (lang) bewegingloos te kunnen blijven liggen. In Nederland hebben zich in het afgelopen decennium ernstige ongevallen voorgedaan tijdens PS voor MRI. Het is aangetoond dat essentiele veiligheidsrichtlijnen ten aanzien van PS onvoldoende geimplementeerd zijn in de Nederlandse algemene kindergeneeskundige praktijk. Tevens bestaan er zorgen over de matige effectiviteit van vaak toegepaste PS-protocollen. Door middel van een enqueˆte onderzochten we welke PS-technieken en -medicijnen algemeen kinderartsen meestal gebruiken voor MRI bij kinderen. De gemiddelde praktijk werd vergeleken met de resultaten van een systematische review (SR) van de recente literatuur. Door middel van de SR proberen we de klinische vraag te beantwoorden wat op de kinderleeftijd de veiligste en meest effectieve techniek is voor PS tijdens MRI. Nederlandse kinderartsen doen voor MRI zelden beroep op anesthesie. Meestal wordt gebruikgemaakt van een PS op basis van chloralhydraat, midazolam en/of lytische cocktails. Deze sedativa hebben een suboptimale effectiviteit. Het is onbekend hoeveel onderzoeken hierdoor geheel of gedeeltelijk mislukken. Deze medicijnen hebben wel een reeel risico op ernstige complicaties. Het gebruik moet daarom steeds gepaard gaan met verregaande voorzorgsmaatregelen en de aanwezigheid van competente professionals. Van alle sedativa heeft propofol de hoogste effectiviteit. Propofol kan veilig worden gebruikt door competente nietanesthesiologen. Indien deze professionals niet beschikbaar zijn, verdient het aanbeveling om kinderen die gesedeerd moeten worden voor MRI, door te verwijzen naar een anesthesioloog.

To evaluate the antitumor activity and toxicity of single-agent cetuximab in patients with recurrent high-grade glioma (HGG) after failure of surgery, radiation therapy, and chemotherapy.In this two-arm, open-label, phase II study patients were stratified according to their epidermal growth factor receptor (EGFR) gene amplification status. Cetuximab was administered intravenously at a dose of 400 mg/m(2) on week 1 followed by weekly dose of 250 mg/m(2). The primary end point for this study was the response rate in both study arms separately.Fifty-five eligible patients (28 with and 27 without EGFR amplification) tolerated cetuximab well. Three patients (5.5%) had a partial response and 16 patients (29.6%) had stable disease. The median time to progression was 1.9 months [95% confidence interval (CI) 1.6-2.2 months]. Whereas the progression-free survival (PFS) was6 months in the majority (n = 50/55) of patients, five patients (9.2%) had a PFS on cetuximab of9 months. Median overall survival was 5.0 months (95% CI 4.2-5.9 months). No significant correlation was found between response, survival and EGFR amplification.Cetuximab was well tolerated but had limited activity in this patient population with progressive HGG. A minority of patients may derive a more durable benefit but were not prospectively identified by EGFR gene copy number.

The Pd-catalyzed aerobic oxidation of various benzyl alcohol derivatives was investigated. Product selectivity is highly dependent on the nature and position of the substituents on the alcohol as well as the level of catalyst loading. Electron-donating substituents increase the reaction rate ( ρ = −0.37), which suggests a partial reduction of the palladium center coupled with alcohol oxidation in the rate-limiting step. The temperature dependence of 4-methoxybenzyl alcohol oxidation was also evaluated, providing activation parameters of Δ H ‡ = 7.4(4) kcal/mol and Δ S ‡ = −53(1) eu. Water is used as the only reaction solvent and air is used as the sole oxidant throughout these studies.

A 6-year-old girl with an inflammatory myofibroblastic tumour of the lung is presented. The radiological features of this lesion are often atypical, as in this case, presenting as progressive atelectasis. The differential diagnosis is extensive and can be difficult, despite modern imaging techniques.

Een preterm geboren mannelijke neonaat ontwikkelde als complicatie van een navelarterielijn enkele weken na de geboorte een arteriele trombose van de aorta. Die werd behandeld met heparine en alteplase waarna volledig herstel volgde. Arteriele trombose van de aorta kan voorkomen als complicatie van een navelarterielijn. Deze complicatie wordt, naast de beschadiging van het endotheel, mede veroorzaakt door het ziektebeloop van de neonaat. Daarnaast is het stollingsmechanisme van de neonaat dusdanig dat er eerder trombose ontstaat dan bloedingsneiging. De incidentie van een symptomatische arteriele trombotische complicatie als gevolg van een navelarterielijn bedraagt 0,3-3%. Hoog geplaatste navelarterielijnen geven een lager risico op klinische vaatcomplicaties in vergelijking met laag geplaatste navelarterielijnen. De diagnose arteriele trombose wordt over het algemeen bevestigd met behulp van echodoppleronderzoek. Ernstige levens-, ledemaat- of orgaanbedreigende trombose dient behandeld te worden. De behandeling bestaat, naast het verwijderen van de lijn indien deze nog in situ is, uit trombolyse indien er onvoldoende effect is van anticoagulantia.

SummaryThe authors have treated 11 solitary cerebral metastases in 9 patients with stereotactic radiosurgery. This relatively new technique of stereotactic single high dose radiotherapy (15–30 Gy to the 70% isodose) is explained. All metastases responded to treatment: six disappeared on CT scan, while the volume of the remaining five diminished significantly. All patients with neurological symptoms had a satisfactory recuperation. There were no complications inherent to the technique. The indications and advantages of this innovative form of «surgical» radiotherapy are discussed.

A preterm infant with mild respiratory insufficiency resulting from respiratory distress syndrome developed a pneumatocele after the start of nasal continuous positive airway pressure. Pneumonia was excluded by sputum and blood cultures. Treatment with high frequency oscillation ventilation resulted in complete recovery.

Substance P is localised in brainstem regions associated with emesis. Based on studies in the ferret, it was postulated that a neurokinin-1 (NK 1 ) receptor antagonist would have antiemetic activity as monotherapy in humans receiving chemotherapy. L-758,298 is a water-soluble, intravenous (i.v.) prodrug for L-754,030, a potent and selective NK 1 receptor antagonist. This double-blind, randomised, active-agent (ondansetron)-controlled study enrolled 53 cisplatin-naive patients and evaluated the prevention of both acute (0–24 h) and delayed (days 2–7) emesis after cisplatin treatment (50–100 mg/m 2 ). All patients received i.v. L-758,298 (60 or 100 mg) ( n =30) or ondansetron (32 mg) ( n =23) before cisplatin and efficacy was evaluated up to day 7 post-cisplatin. Nausea was assessed by means of a four-point ordinal scale at intervals over the 7 day period. In the acute period, the proportion of patients without emesis in the L-758,298 and ondansetron groups was 37 and 52%, respectively (no significant difference between the groups). Comparing the distribution of average nausea scores over the entire first 24 h revealed no significant difference between the groups. In the delayed period, the proportion of patients without emesis in the L-758,298 and ondansetron treatment groups was 72 and 30%, respectively ( P =0.005). The distribution of average nausea scores in the delayed period was lower in the L-758,298 group compared with the ondansetron group ( P =0.15 for the entire delayed period and P =0.043 for day 2 only). No serious adverse events were attributed to L-758,298. A single dose of L-758,298 substantially suppressed the delayed nausea and vomiting characteristic of high dose cisplatin and also appeared to reduce acute emesis post-cisplatin. The data also support the proposition that the underlying mechanism(s) of acute and delayed emesis are different.

B. van der Knoop1, J. I. de Vries1, F. Slaghekke2, S. J. Steggerda3, J. I. Verbeke4, L. S. de Vries5, L. R. Pistorius6 1Obstetrics and Gynaecology, VU University Medical Center Amsterdam, Amsterdam, Netherlands; 2Obstetrics and Gynaecology, Leiden University Medical Center, Leiden, Netherlands; 3Neonatology, Leiden University Medical Center, Leiden, Netherlands; 4Radiology, VU University Medical Center, Leiden, Netherlands; 5Neonatology and Child Neurology, University Medical Center Utrecht, Utrecht, Netherlands; 6Obstetrics and Gynaecology, University Medical Center Utrecht, Utrecht, Netherlands

The authors describe their initial experience with stereotactic radiosurgery of 22 cases with vestibular schwannomas using a linear accelerator. 14 of them with a follow-up of at least one year were studied. 6–9 months after treatment 86% had central tumour necrosis, 71% tumour shrinkage and none of them evidence of tumour growth 3 patients developed reversible facial nerve impairment, 2 had permanent facial numbness. Hearing diminished in one case out of three with normal hearing and in two out of three with already diminished hearing.

The authors describe their initial experience with stereotactic radiosurgery of 22 cases with vestibular schwannomas using a linear accelerator. 14 of them with a follow-up of at least one year were studied. 6-9 months after treatment 86% had central tumour necrosis, 71% tumour shrinkage and none of them evidence of tumour growth 3 patients developed reversible facial nerve impairment, 2 had permanent facial numbness. Hearing diminished in one case out of three with normal hearing and in two out of three with already diminished hearing. Although there is a general consensus that microsurgery is the treatment of choice for these benign tumours, stereotactic radiosurgery challenges this opinion. Stereotactic radiosurgery not only proves to be a valuable alternative for selected cases not suitable for microsurgery, but it is conceivable that it will become the treatment of choice for small vestibular tumours. Tumour control can be obtained in the majority of treated patients with fewer complications and with a higher rate of cranial nerve sparing. This series indicates that linear accelerators can achieve results similar to the Gamma Unit in the treatment of vestibular schwannomas.

TPS134 Background: The overall survival (OS) of newly diagnosed glioblastoma (GB) patients (pts) treated with RT and TMZ is correlated with the methylation status of the MGMT-promoter. Pts with an ...

The authors present the results obtained in seven patients with arteriovenous malformations treated with radiosurgery on a linear accelerator. In four patients obliteration of the malformation was obtained after one year. Two of the patients had a transient period of acute brain oedema surrounding the radionecrotic nidus with neurological signs. The present position of radiosurgery in the treatment of arteriovenous malformations is discussed.

7550 Background: In the CALGB Study Cis with Gem followed by concomitant chemoradiation for inoperable LA-NSCLC was effective, however with significant toxicity (E. Vokes et al; JCO 20: 2002). The aim of this study was to improve tolerability by reducing the Gem dose during radiotherapy and adding one cycle of induction chemotherapy. Methods: Patients with histological proven stage IIIA and IIIB NSCLC were included in this study from 8/04 to 9/07. All patients were to receive 3 induction cycles (21 days) of Cis 80 mg/m2 d1 plus Gem 1250 mg/m2 over 30 minutes d1, 8. After a 3 weeks rest period, 2 cycles of concomitant chemoradiation Cis 80 mg/m2 d1, Gem 300 mg/m2 d1, 8 and RTX (about 60 Gy; 5 times 1,8 Gy fractions / week) were given. Results: A total of 49 patients, median age 63.4 yrs, 73.5% male, with Karnofsky performance status 80/85/90/100: 16.3% / 2.0% / 49.0% / 32.7% were entered. Disease stage IIIA/IIIB: 28.6% / 71.4%. Median dose intensity during chemoradiation Gem 98.4%, Cis 99.0% and radiation median total dose was 63 Gy. Number of grade 3/4 toxicities during induction chemotherapy (N=49): neutropenia 9/9, thrombocytopenia 4/1. Acute grade 3/4 toxicities during chemoradiation phase (N=31): neutropenia 4/0, thrombocytopenia 5/1, radiation esophagitis 4/0 and radiation pneumonitis 1/0. No toxic death. Tumor Response Rate of enrolled patients was 22 (44.9%) (95% CI: 30.7–59.8). Conclusions: Concurrent Cis Gem chemoradiation after Cis Gem induction is an active treatment for LA-NSCLC with managable toxicity. [Table: see text]

Different parameters were measured on patients in six different positions during infratentorial surgery. One group of data served to prove that such patients were in a steady-state as far as their cardiovascular and ventilatory function was concerned. The other measured parameters concerned the intracranial pressure, the intracranial venous pressure and the cerebral perfusion pressure. It appeared from the comparison of these data, that the lateral sitting (45 degrees) position had important advantages and that in this position the possibility of unfavourable features (such as air-embolism) was minimized.

The incidence of postoperative epilepsy in patients who had brain abscesses or subdural empyema is studied in 78 cases. This study is an attempt to answer the question whether prophylactic anticonvulsant drugs influence the natural history of this type of epilepsy.

2017 Background: An increased copy number and mutation of the epidermal growth factor receptor (EGFR) gene are frequently found in high-grade gliomas (HGG). We investigated the activity of the EGFR...