27 results on '"Mònica Cos"'
Search Results
2. Efficacy and safety clinical trial with efavirenz in patients diagnosed with adult Niemann-pick type C with cognitive impairment
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Jordi Gascón-Bayarri, Petru Cristian Simon, Roser Llop, Thiago Carnaval, María Dolores Ledesma, Imma Rico, Cristina Sánchez-Castañeda, Jaume Campdelacreu-Fumadó, Nahum Calvo-Malvar, Mònica Cos, Eugenia de Lama, Montserrat Cortés-Romera, Laura Rodríguez-Bel, Celia Pérez-Sousa, María Cerdán Sánchez, Nuria Muelas, María Dolores Sevillano, Pablo Mir, Adolfo López de Munain, Anna Ferrer, Sebastián Videla, National Neiman-Pick Disease Foundation, Hospital Universitario de Bellvitge, Generalitat de Catalunya, and Carnaval, Thiago more...
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Adult ,Cognition disorders ,Niemann-Pick Disease, Type C ,efavirenz ,General Medicine ,Malalties de Niemann-Pick ,Trastorns de la cognició ,NPC1 ,Clinical trials ,Niemann-pick disease type C ,Humans ,Cognitive Dysfunction ,Niemann-Pick diseases ,Assaigs clínics ,cognitive impairment - Abstract
[Background] Niemann-Pick disease Type C (NPC) is a genetic, incurable, neurodegenerative disorder. This orphan disease is most frequently caused by mutations in the NPC1 protein, resulting in intralysossomal cholesterol accumulation. NPC1 is found in neuronal cell bodies, axon terminals and synaptosomes, suggesting it plays a role in lysosomal degradation pathway and in synaptic transmission. Neuronal function is especially vulnerable to NPC1 deficiency and synaptic changes seem a key element in disease development. Currently, Miglustat (Zavesca®) is the only approved treatment for NPC. However, preclinical evidence showed that low-dose Efavirenz reverted synaptic defects through pharmacological activation of the enzyme CYP46., [Methods] This is a single-center, phase II clinical trial to evaluate the efficacy and safety of Efavirenz in addition to standard of care in patients diagnosed with adult or late juvenile-onset NPC with cognitive impairment. All enrolled patients will be treated orally with 25 mg/d of Efavirenz for 52 weeks (1 year). Secondary objectives include evaluating clinical (neurological and neuropsychological questionnaires) and biological (imaging and biochemical biomarkers) parameters., [Discussion] NPC is still an unmet medical need. Although different therapeutic approaches are under study, this is the first clinical trial (to the best of our knowledge) studying the effects of Efavirenz in adult- and late-juvenile-onset NPC. Despite the small sample size and the single-arm design, we expect the results to show Efavirenz’s capacity of activating the CYP46 enzyme to compensate for NPC1 deficiency and correct synaptic changes, therefore compensating cognitive and psychiatric changes in these patients. This study may provide direct benefit to enrolled patients in terms of slowing down the disease progression., We thank the Spanish Niemann-Pick Foundation for providing financial support. We also thank the Bellvitge University Hospital, IDIBELL and CERCA Program/Generalitat de Catalunya for institutional support. more...
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- 2022
Catalog
3. COVID‐19 and Ischemic Stroke: Clinical and Neuroimaging Findings
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Mònica Cos, Ana Nuñez, Pablo Naval-Baudin, Pere Cardona, Maria Montserrat Fernández Viñas, Albert Pons-Escoda, Nahum Calvo, Isabel Rodriguez Caamaño, Cecilia Rubio-Maicas, and Carles Majós
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Male ,medicine.medical_specialty ,medicine.medical_treatment ,Clinical Neurology ,Infarction ,Neuroimaging ,030218 nuclear medicine & medical imaging ,03 medical and health sciences ,0302 clinical medicine ,Modified Rankin Scale ,Internal medicine ,Occlusion ,medicine ,Humans ,Radiology, Nuclear Medicine and imaging ,Pandemics ,Stroke ,Aged ,Ischemic Stroke ,Retrospective Studies ,Aged, 80 and over ,SARS-CoV-2 ,business.industry ,Microangiopathy ,COVID-19 ,Thrombolysis ,Middle Aged ,medicine.disease ,Arterial occlusion ,Cross-Sectional Studies ,Respiratory failure ,Radiology Nuclear Medicine and imaging ,Cardiology ,Female ,Neurology (clinical) ,Tomography, X-Ray Computed ,business ,030217 neurology & neurosurgery - Abstract
Background and purpose SARS-CoV-2 causes multiorgan disease due to altered coagulability and microangiopathy. Patients may have an increased risk of cerebrovascular accidents (CVA). Our objective was to analyze clinical and neuroimaging characteristics of patients with ischemic CVA during the pandemic peak in our region, in order to identify atypical presentations. Methods We performed a cross-sectional analysis of patients admitted under code-stroke protocol to our center with a final diagnosis of ischemic brain infarction. We analyzed the main imaging and demographic characteristics and reviewed neuroimaging for atypical presentations. Results One-hundred patients with confirmed ischemic CVA were included. Nineteen had positive polymerase chain reaction testing for SARS-CoV-2 on admission. These patients had a lower prevalence of proximal arterial occlusion on imaging, higher in-hospital mortality, and worse baseline disability. No differences were identified in affected vascular territory, volume of infarction, initial CT stroke score, prevalence of hemorrhagic transformation, gender, age, cardiovascular risk factors, time to admission, symptom severity on entry, or decision to treat with thrombolysis or mechanical thrombectomy. Prevalence of COVID-19 in our code-stroke sample was higher than that for our province during this time period. Conclusion The COVID-19 group had more in-hospital mortality, less proximal arterial occlusion on CT or MR angiography, and lower baseline modified Rankin Scale score. We suggest a possibly higher proportion of microangiopathic involvement or undetected distal large-vessel occlusion in the COVID-19 stroke group. Excess mortality was explained by severe respiratory failure. Otherwise, stroke patients with COVID-19 did not differ demographically or clinically from those without the illness. more...
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- 2020
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4. Presurgical Identification of Primary Central Nervous System Lymphoma with Normalized Time-Intensity Curve: A Pilot Study of a New Method to Analyze DSC-PWI
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Noemi Vidal, Mònica Cos, Pablo Naval-Baudin, Alonso Garcia-Ruiz, Jordi Bruna, Gerard Plans, Raquel Perez-Lopez, Albert Pons-Escoda, and Carles Majós
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Adult ,Male ,medicine.medical_specialty ,Adolescent ,Central nervous system ,Neuroimaging ,Pilot Projects ,030218 nuclear medicine & medical imaging ,Metastasis ,Central Nervous System Neoplasms ,White matter ,Meningioma ,Young Adult ,03 medical and health sciences ,0302 clinical medicine ,Image Interpretation, Computer-Assisted ,Humans ,Medicine ,Radiology, Nuclear Medicine and imaging ,Aged ,Retrospective Studies ,Aged, 80 and over ,Normalized Time ,Brain Neoplasms ,business.industry ,Adult Brain ,Area under the curve ,Primary central nervous system lymphoma ,Middle Aged ,medicine.disease ,Magnetic Resonance Imaging ,medicine.anatomical_structure ,Female ,Neurology (clinical) ,Radiology ,business ,Algorithms ,030217 neurology & neurosurgery ,Anaplastic astrocytoma - Abstract
BACKGROUND AND PURPOSE: DSC-PWI has demonstrated promising results in the presurgical diagnosis of brain tumors. While most studies analyze specific parameters derived from time-intensity curves, very few have directly analyzed the whole curves. The aims of this study were the following: 1) to design a new method of postprocessing time-intensity curves, which renders normalized curves, and 2) to test its feasibility and performance on the diagnosis of primary central nervous system lymphoma. MATERIALS AND METHODS: Diagnostic MR imaging of patients with histologically confirmed primary central nervous system lymphoma were retrospectively reviewed. Correlative cases of glioblastoma, anaplastic astrocytoma, metastasis, and meningioma, matched by date and number, were retrieved for comparison. Time-intensity curves of enhancing tumor and normal-appearing white matter were obtained for each case. Enhancing tumor curves were normalized relative to normal-appearing white matter. We performed pair-wise comparisons for primary central nervous system lymphoma against the other tumor type. The best discriminatory time points of the curves were obtained through a stepwise selection. Logistic binary regression was applied to obtain prediction models. The generated algorithms were applied in a test subset. RESULTS: A total of 233 patients were included in the study: 47 primary central nervous system lymphomas, 48 glioblastomas, 39 anaplastic astrocytomas, 49 metastases, and 50 meningiomas. The classifiers satisfactorily performed all bilateral comparisons in the test subset (primary central nervous system lymphoma versus glioblastoma, area under the curve = 0.96 and accuracy = 93%; versus anaplastic astrocytoma, 0.83 and 71%; versus metastases, 0.95 and 93%; versus meningioma, 0.93 and 96%). CONCLUSIONS: The proposed method for DSC-PWI time-intensity curve normalization renders comparable curves beyond technical and patient variability. Normalized time-intensity curves performed satisfactorily for the presurgical identification of primary central nervous system lymphoma. more...
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- 2020
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5. Visualization and documentation of perimortem traits in long bone fractures using computed tomography
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Hannah McGlynn, Sarah Scheirs, Marisa Ortega-Sánchez, Ignasi Galtés, Assumpció Malgosa, and Mònica Cos
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Long bone ,3d model ,Computed tomography ,Documentation ,01 natural sciences ,Pathology and Forensic Medicine ,Fractures, Bone ,03 medical and health sciences ,Imaging, Three-Dimensional ,0302 clinical medicine ,Image Processing, Computer-Assisted ,medicine ,Humans ,Humerus ,Femur ,030216 legal & forensic medicine ,Orthodontics ,medicine.diagnostic_test ,business.industry ,010401 analytical chemistry ,Ulna ,General Medicine ,0104 chemical sciences ,Visualization ,Tension lines ,medicine.anatomical_structure ,Forensic Anthropology ,Tomography, X-Ray Computed ,business - Abstract
Perimortem fracture patterns in long bones, defined in previous publications, include layered breakage, bone scales, crushed margins, flakes with flake defect, wave lines, and plastic deformation. The traits help professionals during trauma analysis to differentiate peri- from post-mortem fractures. This study will therefore investigate whether these traits can be recorded with Computed Tomography (CT) as the non-invasive 3D imaging technique is becoming more popular in forensic science. CT scans of macerated bone samples (n = 15; humerus: n = 1; ulna: n = 1; radius: n = 1; femur: n = 12) were investigated using multi-planar reconstructions (MPRs) and volume renderings. Tension lines and severe plastic deformation were visible on the individual multi-planar reconstructions (MPRs) and the 3D models. Additionally, layered breakage and flake defects were also clearly distinguishable on the volume renderings. Based on the results, CT imaging may be a useful and fast tool to document, visualize, and analyze findings of blunt force trauma. more...
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- 2020
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6. Diagnostic Accuracy of 18F-FDG PET/CT in Patients With Biochemical Evidence of Recurrent, Residual, or Metastatic Medullary Thyroid Carcinoma
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Cristina Gámez Cenzano, Pablo Moreno-Llorente, Manuel Pérez-Maraver, Mònica Cos-Domingo, Susana Rossi-Seoane, Laura Rodriguez-Bel, Jose Luis Vercher Conejero, Montserrat Cortés-Romera, Aida Sabaté-Llobera, and Gabriel Reynés-Llompart more...
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Adult ,Calcitonin ,Male ,medicine.medical_specialty ,Neoplasm, Residual ,endocrine system diseases ,Medullary cavity ,Diagnostic accuracy ,Malignancy ,Sensitivity and Specificity ,030218 nuclear medicine & medical imaging ,Thyroid carcinoma ,Young Adult ,03 medical and health sciences ,0302 clinical medicine ,Fluorodeoxyglucose F18 ,Recurrence ,Positron Emission Tomography Computed Tomography ,medicine ,Carcinoma ,Humans ,Neoplasm ,Radiology, Nuclear Medicine and imaging ,In patient ,Thyroid Neoplasms ,Neoplasm Metastasis ,Aged ,Retrospective Studies ,Aged, 80 and over ,business.industry ,Retrospective cohort study ,General Medicine ,Middle Aged ,medicine.disease ,Carcinoembryonic Antigen ,Carcinoma, Neuroendocrine ,carbohydrates (lipids) ,030220 oncology & carcinogenesis ,Female ,Radiology ,business - Abstract
Medullary thyroid carcinoma (MTC) is a rare malignancy. Location of residual, recurrent, or metastatic disease is crucial to treatment management and outcome. We aimed to evaluate the use of F-FDG PET/CT in localizing MTC foci in patients with biochemical relapse.This is a retrospective cohort study. Review of 51 FDG PET/CT studies of 45 patients referred to restage MTC due to increased calcitonin (Ctn) and carcinoembryonic antigen (CEA) values at follow-up. FDG PET/CT diagnostic accuracy was determined through a patient-based analysis, using histology as criterion standard when available, or other imaging studies and clinical follow-up otherwise (mean, 4 years).There were 25 positive scans. Sensitivity, specificity, positive and negative predictive values, diagnostic accuracy, and positive likelihood ratio were 66.7%, 83.3%, 88.0%, 57.7%, 72.5%, and 4.0, respectively. Using a Ctn cutoff of 1000 pg/mL, sensitivity increased to 76.9%. There were significant differences of Ctn and CEA values between positive and negative FDG PET/CT (P0.05). Regarding true-positive studies, average SUVmax comparing locoregional and metastatic disease was at the limit of significance (P = 0.046).PET/CT can be useful to restage patients with biochemical relapse of MTC, with a better performance in higher Ctn levels. Its high positive predictive value (88%) may impact in the therapeutic management, although its low negative predictive value (57.7%) makes strict follow-up mandatory in examinations without pathologic findings. more...
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- 2019
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7. Precise enhancement quantification in post-operative MRI as an indicator of residual tumor impact is associated with survival in patients with glioblastoma
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Alonso Garcia-Ruiz, Mònica Cos, Nahum Calvo, Gerard Plans, Albert Pons-Escoda, Marta Ligero, Jordi Bruna, Raquel Perez-Lopez, Carles Majós, Pablo Naval-Baudin, Institut Català de la Salut, [Garcia-Ruiz A, Ligero M] Radiomics Group, Vall d’Hebron Institute of Oncology (VHIO), Barcelona, Spain. [Naval-Baudin P] Department of Radiology, Institut de Diagnòstic Per La Imatge (IDI), Bellvitge University Hospital, Barcelona, Spain. [Pons-Escoda A] Department of Radiology, Institut de Diagnòstic Per La Imatge (IDI), Bellvitge University Hospital, Barcelona, Spain. Neuro Oncology Unit, Institut d’Investigació Biomèdica de Bellvitge (IDIBELL), Barcelona, Spain. [Bruna J] Neuro Oncology Unit, Institut d’Investigació Biomèdica de Bellvitge (IDIBELL), Barcelona, Spain. Department of Neurology, Bellvitge University Hospital, Barcelona, Spain. [Plans G] Neuro Oncology Unit, Institut d’Investigació Biomèdica de Bellvitge (IDIBELL), Barcelona, Spain. Department of Neurosurgery, Bellvitge University Hospital, Barcelona, Spain. [Perez-Lopez R] Radiomics Group, Vall d’Hebron Institute of Oncology (VHIO), Barcelona, Spain. Servei Radiodiagnòstic (IDI), Vall d’Hebron Hospital Universitari, Barcelona, Spain, and Vall d'Hebron Barcelona Hospital Campus more...
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Male ,Neoplasm, Residual ,Mathematics and computing ,medicine.medical_treatment ,Neurosurgical Procedures ,Quimioteràpia ,Image Processing, Computer-Assisted ,Càncer de cap ,Multidisciplinary ,medicine.diagnostic_test ,Brain Neoplasms ,Confounding ,Hazard ratio ,Middle Aged ,Prognosis ,Magnetic Resonance Imaging ,neoplasias::neoplasias por tipo histológico::neoplasias de células germinales y embrionarias::tumores neuroectodérmicos::neoplasias neuroepiteliales::glioma::astrocitoma::glioblastoma [ENFERMEDADES] ,Tumor Burden ,Survival Rate ,Neurology ,Oncology ,Medicine ,Female ,Radiology ,medicine.drug ,Adult ,medicine.medical_specialty ,Prognosi ,Science ,Brain tumor ,Radioteràpia ,Glioblastoma multiforme ,Neoplasms::Neoplasms by Histologic Type::Neoplasms, Germ Cell and Embryonal::Neuroectodermal Tumors::Neoplasms, Neuroepithelial::Glioma::Astrocytoma::Glioblastoma [DISEASES] ,Article ,Head cancer ,Young Adult ,Diagnosis::Diagnostic Techniques and Procedures::Diagnostic Imaging::Tomography::Magnetic Resonance Imaging [ANALYTICAL, DIAGNOSTIC AND THERAPEUTIC TECHNIQUES, AND EQUIPMENT] ,medicine ,Mortalitat ,Humans ,Chemotherapy ,diagnóstico::técnicas y procedimientos diagnósticos::diagnóstico por imagen::tomografía::imagen por resonancia magnética [TÉCNICAS Y EQUIPOS ANALÍTICOS, DIAGNÓSTICOS Y TERAPÉUTICOS] ,Mortality ,Diagnosis::Prognosis [ANALYTICAL, DIAGNOSTIC AND THERAPEUTIC TECHNIQUES, AND EQUIPMENT] ,Survival rate ,diagnóstico::pronóstico [TÉCNICAS Y EQUIPOS ANALÍTICOS, DIAGNÓSTICOS Y TERAPÉUTICOS] ,Aged ,Retrospective Studies ,Temozolomide ,Radiotherapy ,business.industry ,Magnetic resonance imaging ,Retrospective cohort study ,medicine.disease ,Imatgeria per ressonància magnètica ,Glioblastoma ,business ,Follow-Up Studies - Abstract
Matemàtiques i informàtica; Neurologia; Oncologia Matemáticas e informática; Neurología; Oncología Mathematics and computing; Neurology; Oncology Glioblastoma is the most common primary brain tumor. Standard therapy consists of maximum safe resection combined with adjuvant radiochemotherapy followed by chemotherapy with temozolomide, however prognosis is extremely poor. Assessment of the residual tumor after surgery and patient stratification into prognostic groups (i.e., by tumor volume) is currently hindered by the subjective evaluation of residual enhancement in medical images (magnetic resonance imaging [MRI]). Furthermore, objective evidence defining the optimal time to acquire the images is lacking. We analyzed 144 patients with glioblastoma, objectively quantified the enhancing residual tumor through computational image analysis and assessed the correlation with survival. Pathological enhancement thickness on post-surgical MRI correlated with survival (hazard ratio: 1.98, p more...
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- 2021
8. Mitochondrial DNA haplogroups J and T increase the risk of glioma
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Maria Pilar Aluja, Juan Jose Acebes, Cristina Santos, Amanda Ramos, Mònica Cos, María del Mar González, Giulio Catalano, and Carlos Alarcon
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0301 basic medicine ,Adult ,Male ,Mitochondrial DNA ,Population ,Biology ,DNA, Mitochondrial ,Haplogroup ,03 medical and health sciences ,0302 clinical medicine ,Glioma ,medicine ,Humans ,Genetic Predisposition to Disease ,education ,Molecular Biology ,Genetics ,education.field_of_study ,Brain Neoplasms ,Cancer ,Cell Biology ,medicine.disease ,Phenotype ,030104 developmental biology ,Increased risk ,Haplotypes ,Molecular Medicine ,Female ,030217 neurology & neurosurgery ,Human mitochondrial DNA haplogroup - Abstract
The presence of different sets of mitochondrial polymorphisms generated by the accumulation of mutations in different maternal lineages has allowed differentiating mitochondrial haplogroups in human populations. These polymorphisms, in turn, may have effects at the phenotypic level, considering a possible contribution of these germinal mutations to the development of certain diseases such as cancer. The main goal of the present study is to establish a possible association between mitochondrial haplogroups and the risk of suffering glioma. Blood samples were obtained from 32 patients from Catalonia (Spain) diagnosed with different grades of glioma (II, III and IV), according to the World Health Organization. The mitochondrial genome was amplified and sequenced using MiSeq 2000 (Illumina). The HaploGrep tool implemented in mtDNA-Server v.1.0.5 was used for the identification of mitochondrial haplogroups. Data obtained in the present study was further pooled with data from previous European studies including glioma patients from Galicia (Spain) and Italy. Results for the Catalonian samples showed an association between individuals with haplogroup J and the increased risk of suffering glioma, with a significant increase of the frequency of individuals with this haplogroup (25%) regarding the general population (7%). Combining different sets of patients with European origin, it appears that individuals with haplogroups J and T have a significantly higher risk of suffering glioma (p 0.001; OR: 2.407 and p = 0.007; OR: 1.82, respectively). This is the first study that establishes an association between different mitochondrial haplogroups and the risk of suffering glioma, highlighting the role of mitochondrial variants in this disease. more...
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- 2020
9. Magnetic resonance spectroscopy in posterior fossa tumours: the tumour spectroscopic signature may improve discrimination in adults among haemangioblastoma, ependymal tumours, medulloblastoma, and metastasis
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Carles Aguilera, Albert Pons, Carles Arús, Angels Camins, Paloma Mora, Amadeo Muntané, Mònica Cos, and Carles Majós
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Adult ,Male ,medicine.medical_specialty ,Magnetic Resonance Spectroscopy ,Posterior fossa ,Infratentorial Neoplasms ,Choline ,030218 nuclear medicine & medical imaging ,Metastasis ,Diagnosis, Differential ,Lesion ,Young Adult ,03 medical and health sciences ,0302 clinical medicine ,Biomarkers, Tumor ,medicine ,Humans ,Radiology, Nuclear Medicine and imaging ,Neoplasm Metastasis ,Retrospective Studies ,Neuroradiology ,Medulloblastoma ,medicine.diagnostic_test ,Receiver operating characteristic ,business.industry ,Ultrasound ,Magnetic resonance imaging ,General Medicine ,medicine.disease ,Magnetic Resonance Imaging ,Hemangioblastoma ,ROC Curve ,030220 oncology & carcinogenesis ,Female ,Radiology ,medicine.symptom ,business ,Inositol - Abstract
Assessing a posterior fossa tumour in an adult can be challenging. Metastasis, haemangioblastoma, ependymal tumours, and medulloblastoma are the most common diagnostic possibilities. Our aim was to evaluate the contribution of magnetic resonance spectroscopy (MRS) in the diagnosis of these entities. We retrospectively evaluated 56 consecutive patients with a posterior fossa tumour and histological diagnosis of ependymal tumour, medulloblastoma, haemangioblastoma, and metastasis in which good-quality spectra at short (TE 30 ms) or/and intermediate (TE, 136 ms) TE were available. Spectra were compared using the Mann-Whitney U non-parametric test in order to select the spectral datapoints and the intensity ratios that showed significant differences between groups of lesions. Performance of these datapoints and their ratios were assessed with ROC curves. The most characteristic signatures on spectroscopy were high choline (Cho) in medulloblastoma (p more...
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- 2018
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10. Invasive Sinonasal Lesions: From the Nasal Fossa and Paranasal Sinuses to the Endocranium
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Mario Huete Naval, Carles Majós, Mònica Cos Domingo, Pablo Naval Baudin, Carles Aguilera, and Albert Pons Escoda
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Pathology ,medicine.medical_specialty ,Nose Neoplasms ,Skull Neoplasms ,Nasal fossa ,Diagnosis, Differential ,03 medical and health sciences ,0302 clinical medicine ,Endocranium ,medicine ,Humans ,Imaging diagnosis ,Neoplasm Invasiveness ,Radiology, Nuclear Medicine and imaging ,030223 otorhinolaryngology ,Neoplasm Staging ,medicine.diagnostic_test ,business.industry ,Magnetic resonance imaging ,Paranasal sinuses ,medicine.anatomical_structure ,Management implications ,030220 oncology & carcinogenesis ,Neoplasm staging ,Radiology ,Differential diagnosis ,business ,Paranasal Sinus Neoplasms - Abstract
The aim of this work is to review the spectrum of sinonasal lesions that extend to the endocranium and to present key points that may narrow the differential diagnosis. The most frequent sinonasal lesions that extend into the endocranium are malignant; however, benign entities are not unusual. Imaging diagnosis is difficult because malignant lesions and benign entities share similar clinical, epidemiologic, and imaging features. Tumor features in relation to bone, intratumor homogeneity and structure, magnetic resonance imaging signal, along with clinical and epidemiologic aspects may allow an appropriate diagnostic focus with important management implications. more...
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- 2018
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11. Imaging of skull vault tumors in adults
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Pablo Naval Baudin, Carles Majós, J. A. Narváez, Carles Aguilera, Albert Pons Escoda, Javier Hernández Gañán, Mònica Cos, and Paloma Mora
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lcsh:Medical physics. Medical radiology. Nuclear medicine ,Hyperostosis ,medicine.medical_specialty ,lcsh:R895-920 ,Tomografia ,Meningioma ,Magnetic resonance imaging ,Cranial vault ,Magnetic resonance spectroscopy ,medicine ,Radiology, Nuclear Medicine and imaging ,Computed tomography ,Tomography ,Educational Review ,Tumors ,Hemangiopericytoma ,business.industry ,Fibrous dysplasia ,Skull Neoplasm ,Aneurysmal bone cyst ,medicine.disease ,Perfusion imaging ,Spectrum analysis ,Skull ,medicine.anatomical_structure ,Skull neoplasms ,Radiology ,business - Abstract
The skull vault, formed by the flat bones of the skull, has a limited spectrum of disease that lies between the fields of neuro- and musculoskeletal radiology. Its unique abnormalities, as well as other ubiquitous ones, present particular features in this location. Moreover, some benign entities in this region may mimic malignancy if analyzed using classical bone-tumor criteria, and proper patient management requires being familiar with these presentations. This article is structured as a practical review offering a systematic diagnostic approach to focal calvarial lesions, broadly organized into four categories: (1) pseudolesions: arachnoid granulations, meningo-/encephaloceles, vascular canals, frontal hyperostosis, parietal thinning, parietal foramina, and sinus pericrani; (2) lytic: fibrous dysplasia, epidermal inclusion and dermoid cysts, eosinophilic granuloma, hemangioma, aneurysmal bone cyst, giant cell tumor, metastasis, and myeloma; (3) sclerotic: osteomas, osteosarcoma, and metastasis; (4) transdiploic: meningioma, hemangiopericytoma, lymphoma, and metastasis, along with other less common entities. Tips on the potential usefulness of functional imaging techniques such as MR dynamic susceptibility (T2*) perfusion, MR spectroscopy, diffusion-weighted imaging, and PET imaging are provided. more...
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- 2020
12. Neurologic Involvement in COVID-19: Cause or Coincidence? A Neuroimaging Perspective
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Nahum Calvo, Albert Pons-Escoda, Carles Majós, Pablo Naval-Baudin, Mònica Cos, Pere Cardona, and Ángels Camins
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Adult ,Male ,Neurologic manifestations of general diseases ,Pediatrics ,medicine.medical_specialty ,Coronavirus disease 2019 (COVID-19) ,Cross-sectional study ,Encephalopathy ,Pneumonia, Viral ,Neuroimaging ,Disease ,Coronavirus infections ,Infeccions per coronavirus ,030218 nuclear medicine & medical imaging ,03 medical and health sciences ,Betacoronavirus ,0302 clinical medicine ,Risk Factors ,Medicine ,Humans ,Radiology, Nuclear Medicine and imaging ,Stroke ,Pandemics ,Aged ,Aged, 80 and over ,Manifestacions neurològiques de les malalties ,business.industry ,SARS-CoV-2 ,Adult Brain ,Perspective (graphical) ,COVID-19 ,Middle Aged ,medicine.disease ,Cross-Sectional Studies ,Encephalitis ,Female ,Neurology (clinical) ,business ,Coronavirus Infections ,030217 neurology & neurosurgery - Abstract
Despite a large cohort of 103 patients with COVID-19, the authors found a large number of symptomatic patients with negative neuroimaging findings, and no conclusions can be drawn concerning concrete associations between neuroimaging and COVID-19. The rapid spread of the coronavirus disease 2019 (COVID-19) pandemic has shaken hospitals worldwide. Some authors suggest that neurologic involvement could further complicate the disease. This descriptive study is a cross-sectional review of 103 patients diagnosed with COVID-19 who underwent neuroimaging (of a total of 2249 patients with COVID-19 in our center). Analyzed variables were neurologic symptoms and acute imaging findings. The most frequent symptoms that motivated neuroimaging examinations were mild nonfocal neurologic symptoms, code stroke (refers to patients presenting with signs and symptoms of stroke whose hyperacute assessment and care is prioritized), focal neurologic symptoms, postsedation encephalopathy, and seizures. No cases of encephalitis or direct central nervous system involvement were detected. Thirteen patients presented with acute ischemic events, and 7, with hemorrhagic events; however, most reported multiple vascular risk factors. Despite the large cohort of patients with COVID-19, we found a large number of symptomatic patients with negative neuroimaging findings, and no conclusions can be drawn concerning concrete associations between neuroimaging and COVID-19. more...
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- 2020
13. Early post-operative magnetic resonance imaging in glioblastoma: correlation among radiological findings and overall survival in 60 patients
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Carles Aguilera, Miguel Gil, Mònica Cos, A. Lucas, Jordi Bruna, Carles Majós, Gerard Plans, and Sara Castañer
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Adult ,Male ,medicine.medical_specialty ,Contrast Media ,Kaplan-Meier Estimate ,Neurosurgical Procedures ,03 medical and health sciences ,Postoperative Complications ,0302 clinical medicine ,Overall survival ,Humans ,Medicine ,Radiology, Nuclear Medicine and imaging ,Postoperative Period ,Survival analysis ,Aged ,Retrospective Studies ,Neuroradiology ,medicine.diagnostic_test ,Brain Neoplasms ,business.industry ,Ultrasound ,Magnetic resonance imaging ,Interventional radiology ,General Medicine ,Middle Aged ,Image Enhancement ,Prognosis ,equipment and supplies ,medicine.disease ,Magnetic Resonance Imaging ,Survival Analysis ,nervous system diseases ,Treatment Outcome ,030220 oncology & carcinogenesis ,Radiological weapon ,Female ,Radiology ,Glioblastoma ,business ,human activities ,030217 neurology & neurosurgery - Abstract
To evaluate early post-operative magnetic resonance (EPMR) as a prognostic tool after resection of glioblastoma.Sixty EPMR examinations were evaluated for perioperative infarct, tumour growth between diagnosis and EPMR, contrast enhancement pattern, and extent of resection (EOR). The EOR was approached with the subjective evaluation of radiologists and by quantifying volumes. These parameters were tested as predictors of survival using the Kaplan-Meier method.Contrast enhancement was found in 59 patients (59/60; 98 %). Showing a thin-linear pattern of enhancement was the most favourable finding. Patients with this pattern survived longer than patients with thick-linear (median overall survival (OS) thin-linear=609 days; thick-linear=432 days; P = .023) or nodular (median OS = 318 days; P = .001) enhancements. The subjective evaluation of the EOR performed better than its quantification. Patients survived longer when resection was total (median OS total resection=609 days; subtotal=371 days; P = .001). When resection was subtotal, patients survived longer if it was superior to 95 % (median OS resection superior to 95 %=559 days; inferior to 95 %=256 days; P = .034).EPMR provides valuable prognostic information after surgical resection of glioblastomas. A thin-linear pattern of contrast enhancement is the most favourable finding. Further prognostic stratification may be obtained by assessing the EOR.• Some kind of contrast enhancement may be found in most EPMR examinations. • Thin-linear enhancements in the EPMR may be considered benign findings. • The EOR evaluated in the EPMR may stratify prognostic groups of patients. • The subjective evaluation of the EOR performs slightly better than its quantification. more...
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- 2015
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14. Correlación radiológico-neuropatológica. Lesión traumática de la médula espinal
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Mònica Cos, Carles Martin-Fumadó, María Ángeles Gallego, Marisa Ortega, and Ignasi Galtés
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Pathology and Forensic Medicine - Abstract
Resumen Se presentan los hallazgos neuropatologicos de la autopsia de una mujer de 80 anos de edad que, tras una caida casual en su domicilio, sufrio un sindrome de compresion medular agudo, falleciendo 9 dias despues del ingreso en el contexto de un cuadro respiratorio agudo. Se realizo estudio neuropatologico mediante extraccion del bloque cervical, congelacion y cortes sagitales seriados del bloque para evaluacion de las lesiones traumaticas. El caso mostro una buena correlacion con los estudios de neuroimagen efectuados. El examen macroscopico de la columna cervical constato la presencia de diversas roturas discales y del ligamento longitudinal anterior, diversos focos hemorragicos paravertebrales, epidurales y centromedulares, y una compresion aguda del cordon medular, sugiriendo un mecanismo lesivo de aceleracion anteroposterior del raquis. La remocion y el estudio del bloque cervical, en casos de sospecha de patologia traumatica, ofrece al patologo las ventajas de un segundo tiempo de autopsia, la posibilidad de comparar con los diagnosticos de neuroimagen y, en ultima instancia, una optima evaluacion de las lesiones neuropatologicas. Implementar la correlacion radiologico-patologica en el campo de la neuropatologia forense puede contribuir al conocimiento epidemiologico y etiopatologico de las lesiones traumaticas del sistema nervioso central. more...
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- 2015
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15. Preradiotherapy MR Imaging: A Prospective Pilot Study of the Usefulness of Performing an MR Examination Shortly before Radiation Therapy in Patients with Glioblastoma
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Albert Pons, Miguel Gil, M. Macià, Carles Majós, Carles Aguilera, A. Fernández-Coello, Mònica Cos, Jordi Bruna, and Sara Castañer
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Adult ,Male ,medicine.medical_specialty ,medicine.medical_treatment ,Neuroimaging ,Pilot Projects ,Kaplan-Meier Estimate ,03 medical and health sciences ,0302 clinical medicine ,medicine ,Humans ,Radiology, Nuclear Medicine and imaging ,In patient ,Prospective Studies ,Pseudoprogression ,business.industry ,Proportional hazards model ,Brain Neoplasms ,Adult Brain ,Middle Aged ,medicine.disease ,Prognosis ,Mr imaging ,Magnetic Resonance Imaging ,Radiation therapy ,Tumor progression ,030220 oncology & carcinogenesis ,Disease Progression ,Female ,Neurology (clinical) ,Radiology ,business ,Glioblastoma ,030217 neurology & neurosurgery ,Chemoradiotherapy - Abstract
BACKGROUND AND PURPOSE: Current protocols in patients with glioblastoma include performing an MR examination shortly after surgery and then 2–6 weeks after ending concomitant chemoradiotherapy. The assessment of this first postradiotherapy examination is challenging because the pseudoprogression phenomenon may appear. The aim of this study was to explore if performing an MR examination shortly before radiation therapy (preradiotherapy MR imaging) could improve the radiologic assessment of patients with glioblastoma. MATERIALS AND METHODS: A preradiotherapy MR imaging examination was prospectively performed before the start of radiation therapy in 28 consecutive patients with glioblastoma who had undergone surgical resection. Tumor response to chemoradiotherapy was assessed twice: with the early postoperative MR examination as baseline and with the preradiotherapy MR imaging examination as baseline. In addition, tumor growth in the preradiotherapy MR imaging examination was evaluated, and its correlation with patient survival was assessed with Kaplan-Meier analysis and Cox regression. RESULTS: Tumor progression after radiation therapy was found in 16 patients, corresponding to pseudoprogression in 7 of them (44%). Four assessments of pseudoprogression switched to partial response or stable disease when preradiotherapy MR imaging was the baseline examination, and the ratio of pseudoprogression was reduced to 25% (3 of 12). Significant differences in survival were found when patients were stratified according to the pattern of tumor growth on preradiotherapy MR imaging (median overall survival “no-growth,” 837 days; “focal-growth,” 582 days; “global-growth,” 344 days; P = .001). CONCLUSIONS: Performing a preradiotherapy MR imaging examination may improve the clinical management of patients with glioblastoma by reducing the ratio of pseudoprogression assessments and providing prognostic information. more...
- Published
- 2016
16. Prospective diagnostic performance evaluation of single-voxel 1H MRS for typing and grading of brain tumours
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Ana Paula Candiota, Carles Aguilera, Mònica Cos, Marta Serrallonga, Indira Coronel, John R. Griffiths, Margarida Julià-Sapé, Carles Majós, J.J. Acebes, and Carles Arús
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Receiver operating characteristic ,medicine.diagnostic_test ,business.industry ,Single voxel ,Magnetic resonance imaging ,medicine.disease ,Histological diagnosis ,medicine ,Molecular Medicine ,Radiology, Nuclear Medicine and imaging ,Medical diagnosis ,Nuclear medicine ,business ,Prospective cohort study ,Grading (tumors) ,Spectroscopy ,Anaplastic astrocytoma - Abstract
The purpose of this study was to evaluate whether single-voxel 1H MRS could add useful information to conventional MRI in the preoperative characterisation of the type and grade of brain tumours. MRI and MRS examinations from a prospective cohort of 40 consecutive patients were analysed double blind by radiologists and spectroscopists before the histological diagnosis was known. The spectroscopists had only the MR spectra, whereas the radiologists had both the MR images and basic clinical details (age, sex and presenting symptoms). Then, the radiologists and spectroscopists exchanged their predictions and re-evaluated their initial opinions, taking into account the new evidence. Spectroscopists used four different systems of analysis for 1H MRS data, and the efficacy of each of these methods was also evaluated. Information extracted from 1H MRS significantly improved the radiologists' MRI-based characterisation of grade IV tumours (glioblastomas, metastases, medulloblastomas and lymphomas) in the cohort [area under the curve (AUC) in the MRI re-evaluation 0.93 versus AUC in the MRI evaluation 0.85], and also of the less malignant glial tumours (AUC in the MRI re-evaluation 0.93 versus AUC in the MRI evaluation 0.81). One of the MRS analysis systems used, the INTERPRET (International Network for Pattern Recognition of Tumours Using Magnetic Resonance) decision support system, outperformed the others, as well as being better than the MRI evaluation for the characterisation of grade III astrocytomas. Thus, preoperative MRS data improve the radiologists' performance in diagnosing grade IV tumours and, for those of grade II–III, MRS data help them to recognise the glial lineage. Even in cases in which their diagnoses were not improved, the provision of MRS data to the radiologists had no negative influence on their predictions. Copyright © 2011 John Wiley & Sons, Ltd. more...
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- 2011
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17. Proton MR Spectroscopy Provides Relevant Prognostic Information in High-Grade Astrocytomas
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Jordi Bruna, Miguel Gil, Mònica Cos, Carles Majós, Carles Arús, Angels Camins, Margarida Julià-Sapé, Carles Aguilera, and J.J. Acebes
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Adult ,Male ,Magnetic Resonance Spectroscopy ,Astrocytoma ,Risk Assessment ,Sensitivity and Specificity ,Risk Factors ,Glioma ,Prevalence ,medicine ,Humans ,Radiology, Nuclear Medicine and imaging ,Aged ,Proportional Hazards Models ,Aged, 80 and over ,Receiver operating characteristic ,Brain Neoplasms ,Proportional hazards model ,business.industry ,Hazard ratio ,Reproducibility of Results ,Brain ,Middle Aged ,Prognosis ,medicine.disease ,Survival Analysis ,Confidence interval ,Intensity (physics) ,Survival Rate ,Spain ,Mann–Whitney U test ,Female ,Neurology (clinical) ,Protons ,Nuclear medicine ,business - Abstract
BACKGROUND AND PURPOSE: There is a large range of survival times in patients with HGA that can only be partially explained by histologic grade and clinical aspects. This study aims to retrospectively assess the predictive value of single-voxel 1 H-MRS regarding survival in HGA. MATERIALS AND METHODS: Pretreatment 1 H-MRS in 187 patients with HGA produced 180 spectra at STE (30 ms) and 182 at LTE (136 ms). Patients were dichotomized into 2 groups according to survival better or worse than the median. The spectra of the 2 groups were compared using the Mann-Whitney U test. The points on the spectrum with the most significant differences were selected for discriminating patients with good and poor prognosis. Thresholds were defined with ROC curves, and survival was analyzed by using the Kaplan-Meier method and the Cox proportional hazards model. RESULTS: Four points on the spectrum showed the most significant differences: 0.98 and 3.67 ppm at STE; and 0.98 and 1.25 ppm at LTE (P between .001 and .011). These points were useful for stratifying 2 prognostic groups (P between .001 and .003, Kaplan-Meier). The Cox forward stepwise model selected 3 spectroscopic variables: the intensity values of the points 3.67 ppm at STE (hazard ratio, 2.132; 95% CI, 1.504–3.023), 0.98 ppm at LTE (hazard ratio, 0.499; 95% CI, 0.339–0.736), and 1.25 ppm at LTE (hazard ratio, 0.574; 95% CI, 0.368–0.897). CONCLUSIONS: 1 H-MRS is of value in predicting the length of survival in patients with HGA and could be used to stratify prognostic groups. ABBREVIATIONS: 1 H-MRS proton MR spectroscopy; Cho choline-containing compounds; CI confidence interval; DWI diffusion-weighted imaging; HGA high-grade astrocytomas; I intensity; KPS Karnofsky Performance Status; LTE long TE; MGMT O6methylguanineDNA methyltransferase; NI normalized intensity; NS not significant; PWI perfusion-weighted imaging; ROC receiver operating characteristic analysis; SE spin-echo; STE short TE; VOI volume of interest; WHO World Health Organization more...
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- 2010
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18. In vivo proton magnetic resonance spectroscopy of intraventricular tumours of the brain
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Carles Majós, Ana Paula Candiota, Carles Aguilera, Carles Arús, Sara Castañer, David Mato, Juan J. Sánchez, Àlex Samitier, Mònica Cos, Angels Camins, J.J. Acebes, and Teresa Delgado-Goñi
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Adult ,Male ,Ependymoma ,Adolescent ,Sensitivity and Specificity ,Metastasis ,Young Adult ,In vivo ,Parenchyma ,Biomarkers, Tumor ,medicine ,Central neurocytoma ,Humans ,Radiology, Nuclear Medicine and imaging ,Aged ,Neuroradiology ,Colloid cyst ,business.industry ,Brain ,Reproducibility of Results ,General Medicine ,Nuclear magnetic resonance spectroscopy ,Middle Aged ,medicine.disease ,Female ,Protons ,Nuclear medicine ,business ,Cerebral Ventricle Neoplasms - Abstract
The aim of this study was to assess the usefulness of proton MR spectroscopy in the diagnosis of intraventricular tumours. Fifty-two intraventricular tumours pertaining to 16 different tumour types were derived from our database. All cases had single-voxel proton MR spectroscopy performed at TE at both 30 and 136 ms at 1.5 T. The Mann-Whitney U test was used to search for the most discriminative datapoints each tumour type. Characteristic trends were found for some groups: high Glx and Ala in meningiomas (p < 0.001 and p < 0.01, respectively), high mobile lipids in metastasis (p < 0.001), high Cho in PNET (p < 0.001), high mI + Gly in ependymoma (p < 0.001), high NAC (p < 0.01) in the absence of the normal brain parenchyma pattern in colloid cysts, and high mI/Gly and Ala in central neurocytoma. Proton MR spectroscopy provides additional metabolic information that could be useful in the diagnosis of intraventricular brain tumors. more...
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- 2009
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19. Biomechanical model of pronation efficiency: New insight into skeletal adaptation of the hominoid upper limb
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Assumpció Malgosa, Mònica Cos, Joan Manyosa, Ignasi Galtés, and Xavier Jordana
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Adult ,Male ,Adaptation (eye) ,Anatomy ,Curvature ,Pronator teres muscle ,Models, Biological ,Biomechanical Phenomena ,Forearm ,medicine.anatomical_structure ,Position (vector) ,Anthropology ,Elbow ,medicine ,Humans ,Upper limb ,Computer Simulation ,Pronation ,Biomechanical model ,Muscle, Skeletal ,Epicondyle ,Mathematics - Abstract
Despite considerable literature on the functional anatomy of the hominoid upper limb, there are no quantitative approaches relating to bone design and the resulting muscular-activity enhancement. The purpose of this study is to quantitatively analyze the relationship between the rotational efficiency of the pronator teres muscle and the design of the skeletal structures on which it acts. Using conventional scan images of a human forearm for three rotational positions, this study develops an original biomechanical model that defines rotational efficiency as a mathematical function expressing a geometrical relationship between the origin and insertion muscular sites. The results show that this parameter varies throughout the entire pronation range, being maximal when the forearm lies around its functional position. Moreover, the rotational-efficiency formula allows us to demonstrate, by several simulation conditions, that an improvement in pronation efficiency is derived from a large shaft radius curvature, a large humeral medial epicondyle, and a more proximal pronator teres radial attachment. The fact that forearm pronation efficiency can be inferred, even quantified, throughout the entire rotational range, by applying the biomechanical model developed here allows us to undertake anatomical approaches in the field of Evolutionary Anthropology, to interpret more precisely how skeletal design is related to upper-limb function in extant and fossil primate taxa. more...
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- 2008
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20. Report on a Stafne Defect in a Man From Medieval Age
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Carlos García Sívoli, Assumpció Malgosa, María Palacios, Xavier Jordana, Mònica Cos, and Ignasi Galtés
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Male ,medicine.medical_specialty ,Jaw Cysts ,Paleopathology ,business.industry ,General surgery ,Stafne defect ,medicine.disease ,History, Medieval ,Surgery ,Otorhinolaryngology ,Spain ,medicine ,Humans ,Mandibular Diseases ,Oral Surgery ,business - Published
- 2007
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21. CT in hepatic cirrhosis and chronic hepatitis
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Eduard Andía, Carlos Valls, Yolanda Roca, Juan Figueras, and Mònica Cos
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Liver Cirrhosis ,medicine.medical_specialty ,Carcinoma, Hepatocellular ,Cirrhosis ,medicine.medical_treatment ,Liver transplantation ,Chronic liver disease ,Hemangioma ,Liver disease ,Hepatic Artery ,medicine ,Humans ,Radiology, Nuclear Medicine and imaging ,Hepatitis, Chronic ,medicine.diagnostic_test ,Portal Vein ,business.industry ,Liver Neoplasms ,medicine.disease ,digestive system diseases ,Liver Transplantation ,Transplantation ,Liver ,Hepatocellular carcinoma ,Angiography ,Radiology ,Tomography, X-Ray Computed ,business ,Liver Circulation - Abstract
Cirrhosis is a diffuse liver disease with premalignant potential in which hepatocellular carcinoma (HCC) frequently develops. The hemodynamics of contrast material are the key to diagnosis of focal liver lesions with computed tomography (CT). Lesions with arterial-dominant vascularity, such as HCC, show brisk enhancement during the arterial phase, whereas lesions with portal blood supply can appear as hyperenhancing lesions in the portal phase. The advent of helical CT has significantly improved the CT examination of the liver because the arterial phase can be displayed independently of the portal phase. The addition of arterial phase imaging to conventional portal phase imaging seems to improve tumor detection and characterization. Although HCC is the single most frequent tumor seen in chronic liver disease, other lesions such as peripheral cholangiocarcinoma and hemangioma should be considered in the differential diagnosis. Optimization of helical CT techniques may allow better detection and characterization of these lesions. In addition to tumor detection, CT plays an important role in preoperative staging of HCC as well as in preoperative assessment of patient candidates to hepatic transplantation. The use of CT angiography with maximum intensity projection techniques may allow for better preoperative work-up and vascular mapping in HCC patients. This article shows the spectrum of helical CT findings in chronic liver disease and specifically in the imaging of HCC and other focal lesions. more...
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- 2002
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22. Delayed postanoxic encephalopathy secondary to acute cocaine and heroin intoxication
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Jordi Gascón-Bayarri, Francisco Rubio, Ramón Reñé, Mònica Cos, Montserrat Juncadella, and Mireia Moragas
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business.industry ,Anesthesia ,Encephalopathy ,medicine ,Radiology, Nuclear Medicine and imaging ,Cerebral anoxia ,medicine.disease ,business ,HEROIN INTOXICATION ,Hyperintensity - Abstract
Delayed postanoxic encephalopathy (DPE) is a rare condition that presents after apparent recovery from acute cerebral anoxia. DPE, which consists of cognitive and neuropsychiatric deficits, appears between one and three weeks after cerebral anoxia. We present a patient with DPE secondary to acute cocaine and heroin intoxication with typical cranial MRI changes. The clinical improvement of the patient could be related to the improvement in white matter lesions despite the characteristics of the ADC map. more...
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- 2009
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23. Traumatic bilateral vertebral artery dissection
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Ignasi, Galtés, Juan Carlos, Borondo, Mònica, Cos, Mercè, Subirana, Carles, Martin-Fumadó, Carles, Martín, Josep, Castellà, and Jordi, Medallo
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Adult ,Forensic pathology ,medicine.medical_specialty ,Time Factors ,Vertebral artery dissection ,Ischemia ,Poison control ,Autopsy ,Dissection (medical) ,Pathology and Forensic Medicine ,Neck Injuries ,Medicine ,Humans ,Forensic Pathology ,Vertebral Artery ,Encephalocele ,Coma ,Vertebral Artery Dissection ,medicine.diagnostic_test ,business.industry ,Accidents, Traffic ,Cerebral Infarction ,medicine.disease ,Surgery ,Bicycling ,Paresis ,Angiography ,Brain Stem Hemorrhage, Traumatic ,Granulation Tissue ,Female ,medicine.symptom ,business ,Tomography, X-Ray Computed ,Law - Abstract
Traumatic vertebral artery dissection is not often seen by forensic pathologists, and cases investigated are scarce in the forensic literature. We present the case of a 40-year-old woman cyclist who was struck by a car while wearing a helmet, and was neurologically near normal immediately thereafter at Emergency. She presented 48 h later with acute right hemiparesis, decreasing level of consciousness, and unsteadiness. CT revealed massive cerebellar infarction. CT angiography was normal. The patient died in coma 7 days after injury and autopsy revealed bilateral edematous cerebellar infarction and bilateral vertebral artery dissection. Rotational neck injury and mural tear in the wall of the Atlantic parts of both vertebral arteries is suggested as the possible mechanism of the arterial injury. Head and neck injuries are reported as a precipitating cause of vertebral artery injury. The possible influence of trauma may be further underestimated if longer intervals between vessel dissection and ischemia occur. The current case illustrates that "talk-and-die" syndrome may be due to occult vertebral artery dissection, possibly bilateral. In forensic cases of delayed death after mild trauma to the head and neck, the vertebral arteries should be examined for the cause of death. more...
- Published
- 2010
24. Rapid palliation of symptoms with platinum-based chemotherapy plus cetuximab in recurrent oral cancer: a case report
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Esther Vilajosana, Ramon Palmero, Mònica Cos, Ricard Mesia, and Silvia Vazquez
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medicine.medical_specialty ,medicine.medical_treatment ,Urology ,Cetuximab ,Antibodies, Monoclonal, Humanized ,Carboplatin ,chemistry.chemical_compound ,Antineoplastic Combined Chemotherapy Protocols ,Case report ,medicine ,Carcinoma ,Humans ,Mouth neoplasm ,Chemotherapy ,business.industry ,Antibodies, Monoclonal ,Pain scale ,Middle Aged ,medicine.disease ,Surgery ,Oncology ,Otorhinolaryngology ,chemistry ,Fluorouracil ,Concomitant ,Carcinoma, Squamous Cell ,Female ,Mouth Neoplasms ,Neoplasm Recurrence, Local ,business ,medicine.drug - Abstract
Background Symptom control is an important consideration in the choice of treatment for patients with recurrent and/or metastatic squamous cell carcinoma of the head and neck (SCCHN). Patients who demonstrate objective tumour responses to platinum-based chemotherapy are more likely to have symptom relief than those who do not have such responses. A phase III trial (EXTREME) showed that adding the epidermal growth factor receptor (EGFR)-targeting IgG1 monoclonal antibody cetuximab to first-line platinum-based chemotherapy significantly prolongs progression-free and overall survival and increases response rate compared with platinum-based chemotherapy alone. We report here the case of a 60-year old female with recurrent squamous cell carcinoma of the gum who had rapid palliation of symptoms and reduction of facial disease mass following treatment with a combination of carboplatin/5-fluorouracil (5-FU) and cetuximab. Case presentation The patient was diagnosed with T4N0 M0 disease of the oral cavity in November 2006 and underwent surgery, with R0 resection, followed by adjuvant radiotherapy and concomitant cisplatin chemotherapy. Around 3 months later, the disease recurred and the patient had severe pain (9/10 on a visual pain scale), marked facial oedema and a palpable facial mass of 89 mm. The patient received 4 21-day cycles of carboplatin (AUC 5), 5-FU (1,000 mg/m2/day for 4 days) and cetuximab (400 mg/m2 initial dose followed by subsequently weekly doses of 250 mg/m2), with continuation of cetuximab monotherapy at the end of this time, and pain relief with topical fentanyl and oral morphine. After 7 days of treatment, pain had reduced to 2/10, with discontinuation of morphine after 4 days, and the facial mass had reduced to 70 mm. After 2 cycles of treatment, the facial mass had decreased to 40 mm. After 3 cycles of treatment, pain and facial oedema had resolved completely and a cervical computed tomography scan showed a marked reduction in tumour mass. Cetuximab monotherapy was continued uninterrupted for 7 months. Conclusion This case illustrates the rapid reduction of tumour mass and disease-associated pain and oedema that can be achieved with a combination of platinum-based chemotherapy and cetuximab in recurrent and/or metastatic SCCHN. more...
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- 2010
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25. Muerte súbita y epilepsia
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Ignasi Galtés and Mònica Cos
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polimicrogiria ,trastornos de la migración neuronal ,neuropatología forense ,malformaciones congénitas ,heterotopia cortical ,Pathology and Forensic Medicine - Abstract
La muerte súbita es una de las principales causas de mortalidad en pacientes epilépticos. Se define por su presentación repentina e inesperada, no traumática, con o sin evidencia de crisis, sin que el examen postmortem revele hallazgos anatómicos o toxicológicos como causa de la muerte. En este sentido, los hallazgos de autopsia suelen ser inespecíficos y por lo que respecta al examen neuropatológico, son raros los casos en los que se puede demostrar la presencia de lesiones encefálicas. En este trabajo, presentamos el caso de un varón de 29 años de edad, con antecedentes de enfermedad epiléptica, que falleció de forma súbita e inesperada mientras dormía. El estudio neuropatológico reveló la presencia de anomalías cerebrales en ambos hemisferios que consistían en trastornos de la sulcación y de la migración neuronal. Se realiza la descripción macroscópica de estas malformaciones congénitas, las cuales con frecuencia se manifiestan clínicamente en forma de crisis comiciales. more...
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- 2009
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26. Pretransplantation diagnosis and staging of hepatocellular carcinoma in patients with cirrhosis: value of dual-phase helical CT
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Eduard Andía, Juan Figueras, Carlos Valls, Teresa Serrano, Jaume Torras, Anna Sánchez, Mònica Cos, and Emilio Ramos
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Adult ,Liver Cirrhosis ,Male ,Cirrhosis ,Carcinoma, Hepatocellular ,medicine.medical_treatment ,Liver transplantation ,Preoperative care ,Angioma ,Predictive Value of Tests ,Preoperative Care ,Carcinoma ,Medicine ,Humans ,Radiology, Nuclear Medicine and imaging ,Prospective Studies ,Aged ,Neoplasm Staging ,business.industry ,Liver Neoplasms ,Reproducibility of Results ,General Medicine ,Middle Aged ,medicine.disease ,Liver Transplantation ,Transplantation ,Predictive value of tests ,Hepatocellular carcinoma ,Female ,business ,Nuclear medicine ,Tomography, Spiral Computed - Abstract
The objective of our study was to prospectively evaluate the results of helical CT in the detection of hepatocellular carcinoma (HCC) in patients with cirrhosis undergoing orthotopic liver transplantation. SUBJECTS AND METHODS. Eighty-five patients with cirrhosis were studied preoperatively with biphasic helical CT. Arterial, portal, and equilibrium phase images were obtained after injection of 170 mL of contrast material at 5 mL/sec. The prospective CT interpretation was compared with pathologic results on a lesion-by-lesion basis.Pathologic examination found 85 cases of HCC in 51 patients. Helical CT enabled a correct diagnosis of HCC in 67 of 85 lesions for a sensitivity of 78.8%. HCC nodules were hypervascular in the arterial phase and hypovascular in the equilibrium phase in 63.5% (54/85) of patients. The false-negative rate was 21% (n = 18), and the positive predictive value was 88%. We had nine false-positive findings (11.8%) related to hemangiomas, transient hepatic attenuation differences, and regenerative nodules. Helical CT detected 61% (23/38) of lesions smaller than 2 cm and 93.6% (44/47) of lesions 2 cm or larger.Helical CT is a useful preoperative imaging technique in cirrhotic patients who are candidates for orthotopic liver transplantation, although it is relatively insensitive for detection of small lesions (2 cm). more...
- Published
- 2004
27. Corrigendum to 'Traumatic bilateral vertebral artery dissection' [Forensic Sci. Int. 214 (2012) e12–e15]
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Ignasi Galtés, Jordi Medallo, Juan Carlos Borondo, M. Subirana, Carles Martin-Fumadó, Mònica Cos, and Josep Castellà
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business.industry ,INT ,Bilateral vertebral artery dissection ,Medicine ,business ,Law ,Humanities ,Pathology and Forensic Medicine - Abstract
Corrigendum to ‘‘Traumatic bilateral vertebral artery dissection’’ [Forensic Sci. Int. 214 (2012) e12–e15] Ignasi Galtes *, Juan Carlos Borondo , Monica Cos , Merce Subirana , Carles Martin-Fumado , Josep Castella , Jordi Medallo a a Institut de Medicina Legal de Catalunya, Ciutat de la Justicia n8 111, Edifici G, Gran Via de les Corts Catalanes, 08075 Barcelona, Catalonia, Spain b Instituto Nacional de Toxicologia Barcelona, Departamento de Anatomia Patologica, C/Merce n8 1, 08014 Barcelona, Catalonia, Spain c Institut de Diagnostic per la Imatge (IDI), Hospital Universitari de Bellvitge, 08907 L’Hospitalet de Llobregat, Barcelona, Catalonia, Spain more...
- Published
- 2013
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