bluuebunny/crossref_metadata_2025 huggingface dataset:
A review of the studies on food-derived factors which regulate energy metabolism via the modulation of lipid-sensing nuclear receptors
Authors: Goto Tsuyoshi
Published: December 2018

Obesity is one of the most important risk factors for chronic metabolic disorders. Molecular mechanisms underlying obesity-related metabolic disorders have not been completely elucidated. Peroxisome proliferator-activated receptors (PPARs) are members of the nuclear receptor superfamily and are key metabolic regulators of the whole-body energy metabolism. Certain enzymes involved in carbohydrate and lipid metabolism are directly regulated by PPARs via their interaction with specific response elements in their gene promoters. Many food factors act as ligands of PPARs and regulate carbohydrate and lipid metabolism by regulating the activities of these nuclear receptors, leading to the attenuation of obesity-related metabolic disorders. In this review, we describe our current knowledge of the role of PPARs in the regulation of whole-body energy metabolism and several examples of food factors that act as ligands of PPARs, which may be useful in the management of obesity and the accompanying energy metabolism abnormalities.

Abbreviations: WAT: white adipose tissue; PPAR: Peroxisome proliferators-activated receptor; RXR: retinoid X receptors; mTORC1: mechanistic target of rapamycin complex 1; PPRE: PPAR-responsive regulatory elements; NAFLD: nonalcoholic fatty liver disease; LPL: lipoprotein lipase; FGF21: fibroblast growth factor 21; BAT: brown adipose tissue; UCP1: uncoupling protein 1; LPC(16:0): 1-palmitoyl lysophosphatidylcholine; C/EBP: CCAAT-enhancer binding proteins; STAT5A: signal transduction and activator of transcription 5A; APO apolipoptotein; CBP: cAMP response element-binding protein-binding protein; PGC1A: PPARγ coactivator protein 1a; HFD: high-fat diet; TG: triglyceride; VLDL: very low density lipoprotein; HDL: high density lipoprotein
Autophagosome maturation: An epic journey from the ER to lysosomes
Authors: Zhao Yan G. , Zhang Hong
Published: December 2018

Macroautophagy involves the sequestration of cytoplasmic contents in a double-membrane autophagosome and their delivery to lysosomes for degradation. In multicellular organisms, nascent autophagosomes fuse with vesicles originating from endolysosomal compartments before forming degradative autolysosomes, a process known as autophagosome maturation. ATG8 family members, tethering factors, Rab GTPases, and SNARE proteins act coordinately to mediate fusion of autophagosomes with endolysosomal vesicles. The machinery mediating autophagosome maturation is under spatiotemporal control and provides regulatory nodes to integrate nutrient availability with autophagy activity. Dysfunction of autophagosome maturation is associated with various human diseases, including neurodegenerative diseases, Vici syndrome, cancer, and lysosomal storage disorders. Understanding the molecular mechanisms underlying autophagosome maturation will provide new insights into the pathogenesis and treatment of these diseases.
Epilepsy-associated mutations in the voltage sensor of KCNQ3 affect voltage dependence of channel opening
Authors: Barro-Soria Rene
Published: December 2018

One of the major factors known to cause neuronal hyperexcitability is malfunction of the potassium channels formed by KCNQ2 and KCNQ3. These channel subunits underlie the M current, which regulates neuronal excitability. Here, I investigate the molecular mechanisms by which epilepsy-associated mutations in the voltage sensor (S4) of KCNQ3 cause channel malfunction. Voltage clamp fluorometry reveals that the R230C mutation in KCNQ3 allows S4 movement but shifts the open/closed transition of the gate to very negative potentials. This results in the mutated channel remaining open throughout the physiological voltage range. Substitution of R230 with natural and unnatural amino acids indicates that the functional effect of the arginine residue at position 230 depends on both its positive charge and the size of its side chain. I find that KCNQ3-R230C is hard to close, but it is capable of being closed at strong negative voltages. I suggest that compounds that shift the voltage dependence of S4 activation to more positive potentials would promote gate closure and thus have therapeutic potential.
A Step Forward Toward the Understanding of the Long-Term Pathogenesis of Double Capsule Formation in Macrotextured Implants: A Prospective Histological Analysis
Authors: Glicksman Caroline A , Danino Michel A , Efanov Johnny I , El Khatib Arij , Nelea Monica
Published: December 2018

Background

Although increasingly reported in the literature, most plastic surgeons cannot define the etiology of double capsules. Often an incidental finding at implant exchange, double capsules are frequently associated with macrotextured devices. Several mechanisms have been proposed, including at the forefront that shearing causes a delamination of the periprosthetic capsule into a double capsule.

Objectives

This study was designed to confirm the hypothesis that mechanical forces are involved in formation of double capsules by histological analysis.

Methods

A prospective analysis of consecutive implants with double capsules removed over 2 years was performed. Data collected at the time of surgery included Baker classification, reason for explant, implant manufacturer and style, and any presence of a seroma associated with the capsule. Specimens were sent for analysis by histology utilizing hematoxylin and eosin and alpha-smooth muscle actin staining techniques.

Results

Eight double capsules were collected for specimen analysis. All capsules demonstrated evidence of granulation tissue, alpha-smooth muscle actin positive myofibroblasts, and folds with embedded texture. Fibrosis surrounded weak areas with presence of layering and splitting, creating a potential space that is prone to separation. Tears and folds from granulomatous reaction are also present within the outer layer of the double capsule, which can only be explained by a mechanical shearing force as a pathogenic mechanism.

Conclusions

Understanding the pathogenesis of double capsules may allow plastic surgeons to refine their indications for macrotextured implants while providing guidance to patients on avoidance of activities that produce shear-forces. The findings support the hypothesis that shearing forces delaminate the capsule into 2 separate distinct capsules.

Level of Evidence: 5
Switching From a Protease Inhibitor–based Regimen to a Dolutegravir-based Regimen: A Randomized Clinical Trial to Determine the Effect on Peripheral Blood and Ileum Biopsies From Antiretroviral Therapy–suppressed Human Immunodeficiency Virus–infected Individuals
Authors: Morón-López Sara , Navarro Jordi , Jimenez Montse , Rutsaert Sofie , Urrea Víctor , Puertas Maria C , Torrella Ariadna , De Clercq Laura , Ribas Bibiana Planas , Gálvez Cristina , Salgado Maria , Vandekerckhove Linos , Blanco Julià , Crespo Manel , Martinez-Picado Javier
Published: December 2018

Background

Optimization of combination antiretroviral therapy (cART) can impact the human immunodeficiency virus (HIV) reservoir. We evaluated the effect on the HIV reservoir in peripheral blood and ileum biopsies in patients switching from boosted protease inhibitor (PI/r)–based therapy to dolutegravir (DTG)–based therapy.

Methods

Impact of Integrase-inhibitor DOlutegravir On the viral Reservoir (INDOOR) is a phase 4 open-label clinical trial that randomly included 42 HIV type 1–infected individuals on effective cART: 20 who switched from PI/r-based to DTG-based cART (switch group), and 22 who remained in PI/r-based regimens (control group). We analyzed blood and ileum biopsies to quantify episomal, total, and integrated HIV DNA, cell-associated HIV RNA, residual plasma viremia, T-cell subsets, cell activation, and inflammation markers.

Results

There were no related adverse events or treatment discontinuations due to drug intolerance. The HIV reservoir was consistently larger in ileal than in peripheral CD4+ T cells in both groups (P < .01). Residual viremia in plasma decreased in the switch group (P = .03). However, we did not observe significant longitudinal changes in low-level viral replication, total and integrated HIV reservoir, HIV transcription, T-cell maturation subsets, immunoactivation markers, inflammatory soluble proteins, or cellular markers of latently infected cells.

Conclusions

The INDOOR study is the first evaluation of changes in HIV reservoir size in ileum biopsies and in peripheral blood in individuals switched from PI/r- to DTG-based cART. Although this switch was safe and well tolerated, it had no impact on a large array of immunological and inflammatory markers or on HIV reservoir markers in peripheral or in ileal CD4+ T cells.

Clinical Trials Registration

EudraCT 2014-004331-39.
One-stage aortic replacement for type A aortic dissection: using a Vasoring and a conventional elephant trunk graft
Authors: Wei Jeng , Lee Yung-Tsai , Wu Ching-Wen
Published: December 2018

OBJECTIVES

We used a vascular ring connector (Vasoring) and a conventional elephant trunk graft for complete repair in open surgery for type A aortic dissection. This report described the immediate and mid-term results of this new technique.

METHODS

We used a rigid titanic ring as a stent in the vascular graft for rapid sutureless anastomosis in the reconstruction of type A aortic dissection.

RESULTS

A total of 65 consecutive patients with Stanford type A aortic dissection underwent open surgery performed by a single surgeon from November 2007 to February 2017. All patients underwent aortic reconstruction with vascular grafts and Vasorings (21 patients in the ascending aorta and 44 patients in the total aortic arch). For total aortic arch replacement, we implanted the conventional vascular graft in the proximal descending thoracic aorta as an elephant trunk graft. Concomitant procedures included the Bentall procedure (9 patients), the David operation (6 patients), coronary artery bypass grafting (9 patients), heart transplantation (1 patient), mitral valve replacement (2 patients) and endovascular aortic repair (1 patient). The mean duration of postoperative endotracheal intubation was 17.0 ± 11.8 h. The average blood loss was 520 ± 743 ml, and 25% of patients required no blood transfusion. The in-hospital mortality rate was 6%.

CONCLUSIONS

The combined use of the vascular ring connector and the conventional elephant trunk graft may reduce bleeding and pump time, stop the blood flow in the false lumen and allow the 1-stage total arch replacement to be performed safely. The conventional elephant trunk graft is free from stent graft-induced new entry.
Head Trauma
Authors: Thomsen Todd W.
Published: December 2018

Head injury is often associated with other serious trauma. Clinical decision rules such as the Canadian CT Head Rule can guide clinicians in the judicious use of neuroimaging, which can then guide the appropriate course of treatment. Rapid assessment of patients requiring neurosurgical intervention is critical, as is appropriate management of blood pressure and hypoxia. This chapter considers a case study of blunt head injury with loss of consciousness of a skier in the backcountry, The author addresses patient history, physical exam, differential diagnoses, clinical course, and key management steps. The patient’s condition relative to the Canadian CT Head Rule is specifically discussed.
Hypothermia
Authors: Malka S. Terez
Published: December 2018

Hypothermia occurs when the body’s core temperature drops below 35°C (95°F). Symptoms increase as body temperature decreases. Symptoms can include (from mild to severe): shivering, decreased fine motor dexterity, impairment in judgment, gait instability, decreased mental status, and loss of consciousness. Rapid rewarming is critical. A hypothermic patient should not be considered dead until “they are warm and dead.” This chapter highlights a case of profound hypothermia caused by cold water immersion. The chapter details the case, including the history, physical exam, and treatment. Key management points include the assumption of complicating traumatic injury or medical illness until rewarming is complete; active core rewarming; continuous cardiopulmonary resuscitation until goal core temperature is achieved; understanding that prolonged cardiopulmonary resuscitation may be necessary; and the recognition of Osborne J waves on the electrocardiogram.
Vomiting
Authors: Dorsett Maia
Published: December 2018

This case illustrates the priorities of management in a patient with acute organophosphate toxicity in the prehospital environment. Organophosphates are common components of pesticides. They act as toxins and can lead to development of the cholinergic toxidrome by blocking breakdown of the neurotransmitter acetylcholine at nerve endings. The cholinergic toxidrome is a clinical syndrome marked by parasympathetic excess (bradycardia, bronchorrhea, bronchospasm, miosis, lacrimation, salivation, urination, and defecation), neuromuscular junction activation (muscle fasciculations), and central nervous system toxicity (delirium and seizures). The priorities of care in organophosphate exposure include rapid administration of antidote (atropine and pralidoxime), airway management, and patient decontamination to prevent further toxin absorption. Medical providers must always protect themselves in the case of toxic exposure and should wear double nitrile gloves at all times when handling the patient or their clothing.
Excited Delirium
Authors: Williams Thomas
Published: December 2018

Excited delirium poses a challenging diagnostic and management issue for many prehospital providers. These patients can be agitated, aggressive, violent, and often require additional resources to restrain them. Excited delirium may be precipitated by a variety of factors, including psychiatric disturbance, metabolic derangement, and intoxication. Providers may need to coordinate with law enforcement officials or reach for sedative medications to safely assess and manage them. This chapter describes some of the key features of excited delirium, discusses common precipitants of this state, and provides management strategies for these patients, including the use of sedatives. This chapter also discusses some of the adverse reactions to sedative medications and what to do if these arise.
Stridor
Authors: Donovan Sean , Cordi Heidi
Published: December 2018

This case illustrates acute respiratory distress in pediatric patient populations. More specifically, it highlights signs of upper airway obstruction, including stridor. This type of presentation most frequently occurs with croup, also known as laryngotracheobronchitis, but can also occur in other pathologic conditions, which are briefly discussed. Croup is a viral infection that causes upper respiratory tract symptoms, including a harsh “seal-like” barking cough, secondary to mucosal edema in the upper airway. Significant swelling can cause respiratory distress with development of stridor, prompting treatment with nebulized epinephrine. In addition, steroid medication is often administered for longer term symptom control. Most children recover well in a relatively short time period.
Failing Asthmatic
Authors: Poliner David , Nawrocki Philip , Lawner Benjamin J.
Published: December 2018

This case presents a patient with an acute asthma exacerbation progressing to respiratory failure. The differential diagnosis of acute respiratory distress is discussed along with the signs and diagnostic adjuncts that may be used to confirm the diagnosis of status asthmaticus. Treatment of severe acute asthma may include oxygen, albuterol, epinephrine, steroids, and magnesium. The signs of respiratory failure are reviewed along with its initial management, the use of noninvasive ventilation, and the use of rapid sequence induction to intubate and perform mechanical ventilation to the patient in respiratory failure. Ventilator settings for patients with restrictive lung disease are also discussed.
Blunt Chest Trauma
Authors: Shocket Daniel
Published: December 2018

This case involves a blunt trauma patient being managed from the viewpoint of a helicopter critical care team sent to rendezvous with a ground ambulance for transport of a critical patient to a trauma center. Topics discussed include many logistical considerations, a focused differential diagnosis, the evaluation and management of a trauma patient both on the ground and in a helicopter, and the further management after arrival to an emergency department. Tranexamic acid (TXA) use, blood product versus crystalloid administration, and the utility of the Focused Assessment with Sonography in Trauma (FAST) exam are also discussed.
Weakness
Authors: Farney Aaron
Published: December 2018

Acute ischemic strokes have significant morbidity and mortality, particularly when they involve a large vessel occlusion. This case reviews the prehospital presentation of a patient with a large vessel occlusion stroke, the critical role prehospital personnel have in recognizing a stroke, determining the most appropriate facility, and identifying the most appropriate transport modality. Approaches to managing the unconscious patient’s airway are discussed, with particular attention to the effects intubation may have on intracranial pressure. As large vessel occlusion ischemic strokes have a therapeutic option not previously available, the role of prehospital identification and destination determination is even more critical ,and this case reviews those considerations.
Extremity Swelling
Authors: Repanshek Jennifer
Published: December 2018

The case illustrates the classic clinical features and emergent management of rhabdomyolysis. The pathophysiology results from the breakdown of muscle from intense exercise, drug or alcohol use, seizure activity, trauma, heat illness, or muscle disorders. The clinical history is of a severe muscle pain, sometimes focused on a single muscle group or extremity but often diffuse. Rhabdomyolysis should be suspected in a patient with vague complaints of muscle pain, and an elevation in creatine kinase is diagnostic in this clinical picture. Patients who have been diagnosed with rhabdomyolysis must also be carefully evaluated for compartment syndrome. The mainstay of treatment is aggressive intravenous fluid administration. Serial creatine kinase values as well as the patient’s evolving clinical status should guide further management.
Fever
Authors: Morgan Sarah
Published: December 2018

This chapter focuses on evaluation of a patient in the intensive care unit who develops fever in the setting of an indwelling central line and urinary catheter. Focus is on the development of a differential including central line associated blood stream infection, catheter-associated urinary tract infection, and hospital-acquired pneumonia as the most likely etiology of the patient’s decompensation. Emphasis is on rapid source control and treatment to control sepsis and decompensation to shock. Key management steps include consideration of the most likely sources of infection in the patient who develops fever while in the intensive care unit; securing a complete blood count, lactate, and blood cultures prior to empiric antibiotics; the rapid source control with removal and, if needed, replacement of indwelling lines; and administering appropriate empiric antibiotics within 6 hours of diagnosis of infection.
Abdominal Distention
Authors: Rajpal Megha
Published: December 2018

This chapter presents the case of a young burn victim who developed secondary abdominal compartment syndrome from fluid resuscitation. It discusses the difference between intra-abdominal hypertension (IAH) and abdominal compartment syndrome (ACS). It also reviews the rule of nines to calculate the percentage of body surface area burned and the Parkland formula to calculate fluid requirements in burn victims. Key management points include recognizing that patients receiving aggressive fluid resuscitation are at risk for development of IAH and ACS and knowledge of the clinical signs (low urine output, increased peak pressures, decreased tidal volumes, and hypotension) and risk factors of ACS.
Tachycardia
Authors: Miller Stephen
Published: December 2018

The case illustrates the approach to the evaluation and management of monomorphic ventricular tachycardia. Clinical management of this potential life-threatening arrhythmia begins with the early recognition of rhythm morphology and duration, as well as patient stability. Timely interventions with electrical cardioversion, antiarrhythmic pharmacology, and evaluation of potential etiologies such as acute ischemia, hypoxia, and electrolyte abnormalities, are vital to the care of the patient. The management key points including recognizing a change in cardiac rhythm with wide complex tachycardia, use of a cardiac monitor and appropriately placed defibrillator pads, identification of a sustained ventricular tachycardia and the need for electrical cardioversion, dosing with antiarrhymthmic medication and proper evaluation of the etiology of the ventricular tachycardia, and following with a cardiology consult and transfer to intensive care unit.
No Urine Output
Authors: Rodger Alison
Published: December 2018

The chapter describes a case of acute urinary retention to illustrate the clinical approach to anuria. It reviews the differential diagnosis and initial work up for anuria considering prerenal, renal, and postrenal etiologies. This work up includes serum chemistry, urinalysis, urine culture, urine electrolytes, urine creatinine, urine osmolality, and bedside bladder ultrasound. It discusses the causes of acute urinary retention including neurologic, obstructive, infectious, inflammatory, medication induced, or traumatic causes, and also illustrates the management of acute urinary retention..Urethral catheterization to decompress the bladder is the first-line treatment for acute urinary retention, which is followed by treatment of the underlying cause or causes.
Fever
Authors: Patriquin Glenn
Published: December 2018

This case illustrates one of the most common healthcare-associated infections (HAI) in a patient who is admitted to hospital. Catheter-associated urinary tract infections (CAUTI) can be prevented by eliminating unnecessary urinary catheter use. Furthermore, non-specific symptoms are frequently erroneously attributed to a presumed urinary tract infection (UTI) upon isolating bacteria from a urine sample. Except for a few specific circumstances, asymptomatic bacteriuria should not be treated with antibiotics. Without symptoms consistent with UTI, growth of bacteria from urine does not constitute an infection. Culturing urine without UTI symptoms can lead to misuse of antibiotics, which can increase adverse events and drive antimicrobial resistance. This case reviews common causes of UTIs and criteria for diagnosis.
Chest Pain
Authors: Caddell Andrew
Published: December 2018

This case addresses symptomatic severe aortic stenosis (AS). AS symptoms typically are chest pain, dyspnea, and syncope. Physical exam findings of AS may be present regardless of severity of aortic stenosis, and they include slow rate of rise of the carotid pulse, mid- to late peak intensity of the murmur, and decreased intensity of the second heart sound. Medical management of symptomatic aortic stenosis is challenging. In the presence of the fixed outlet obstruction of AS, vasodilators (such as nitroglycerin) must be used with caution. The definitive management of aortic stenosis is surgical. Among frail patients, transcatheter aortic valve implantation is a reasonable alternative to open surgery.
Agitation
Authors: Green Christopher J. M.
Published: December 2018

Acute agitation is a common issue encountered among patients admitted to inpatient wards, and it has a broad differential diagnosis. When confronted with an agitated inpatient, it is important to consider the underlying etiology before administering any sedatives so that patients receive appropriate management. This case illustrates a possible cause of agitation, alcohol withdrawal, which is potentially life-threatening if not recognized. Discussion focuses on the signs and symptoms that allow alcohol withdrawal to be distinguished from other causes of inpatient agitation, as well as key aspects of management including administration of benzodiazepines and thiamine, and avoidance of medications that lower seizure threshold (e.g., antipsychotics).
Dyspnea
Authors: Balan Marko
Published: December 2018

Acute-onset dyspnea is a common symptom of hospitalized patients. This chapter describes the diagnostic approach and evaluation, and outlines not-to-be-missed diagnoses in patients with this common complaint. Important aspects of the history and physical examination of acutely dyspneic patients is also discussed with particular emphasis on the significance and interpretation of B lines on thoracic point-of-care ultrasound. Finally, the chapter concludes with a description of the initial treatment of congestive heart failure, including medical care and considerations regarding ventilatory support. The chapter illustrates a case of a woman who presents to hospital with dehydration and weakness secondary to a urinary tract infection. The patient’s unstable and deteriorating respiratory status necessitates transfer to a monitored unit, where she is evaluated for acute-onset dyspnea and treated for congestive heart failure.
Swollen Eyes
Authors: Meyer Jeff
Published: December 2018

This case demonstrates a typical presentation of nephrotic syndrome. Most often occurring in patients ages 2 to 6 years of age, nephrotic syndrome is characterized by edema, and urinalysis will reveal substantial proteinuria. Minimal change disease is the most common underlying etiology of nephrotic syndrome, and remission can usually be achieved by treatment with corticosteroids. Key management points include recognizing the clinical presentation of nephrotic syndrome; correct diagnosis by urinalysis where nephrotic-range proteinuria is present and hypertension, gross hematuria, and renal insufficiency are absent; and initiation of appropriate corticosteroid therapy, which in most cases leads to remission, though recurrence is possible..
Chest Pain
Authors: Bellis Jennifer
Published: December 2018

This chapter reviews the evaluation, workup, diagnosis and treatment of chest pain in a child. Additionally, it reviews common causes of pediatric chest pain as well as important components of the history and physical that may indicate a more serious cause of pediatric chest pain. These patients may require further diagnostic procedures or referral to a subspecialist for further evaluation. Finally, it discusses the role of electrocardiogram and chest X-rays in the workup of pediatric chest pain. In general, most adolescent occurrence of chest pain has a benign etiology, commonly with a musculoskeletal cause. Absent other abnormal findings, these patients often require only a minimal workup.
Crush Injury
Authors: Perry Christopher M.
Published: December 2018

This chapter examines compartment syndrome as it may be evaluated in the field with limited resources, as well as clinical correlations for compartment syndrome evaluation in a more common civilian trauma setting. It reviews the situations in which one might suspect compartment syndrome, explaining the clinical symptoms, physical examination, differential diagnosis, relevant laboratory testing, and imaging to consider when initially evaluating a patient for possible compartment syndrome, including crush injuries and rhabdomyolysis. Additionally, it discusses indications for measuring compartment pressure and best practices for utilizing commercially available equipment. There is a discussion of fasciotomy indications and recommendations regarding pressure measurement techniques. Finally, there is a brief discussion of practices that are not recommended when treating compartment syndrome.
Abdominal Pain
Authors: DeVos Elizabeth
Published: December 2018

This case demonstrates a common presentation of appendicitis including frequent signs and symptoms and classic examination findings. Options for diagnostic imaging are reviewed. Clinical decision scores may assist in risk stratification, which may be particularly useful in austere or low-resource settings. The discussion introduces the concept of “antibiotics first” treatment for appendicitis including a discussion of patients who are poor candidates for such treatment, risks for need of future operative management, and proposed treatment protocols. While surgical management remains the standard of care in the United States, this case discusses potential utility for an “antibiotics first” protocol when definitive surgical treatment is not readily available.
Eye Injury
Authors: Mohseni Michael
Published: December 2018

The case is an example of traumatic globe rupture. Most cases occur after penetrating trauma though blunt trauma may also be implicated. Rupture should be suspected in the setting of vision loss, any globe deformity, and eye pain. A search for any concomitant facial or intracranial injuries should be pursued. Once globe rupture is identified, supportive measures should be established to prevent any worsening or extrusion of eye contents. This includes avoiding manipulation or tonometry of the eye, minimizing Valsalva, placing a rigid eye shield, and appropriate analgesia. Definitive treatment is dictated by the consulting ophthalmologist and likely involves surgical repair.
Dyspnea and Hemoptysis after a Rigorous, Open-Water Swim
Authors: Engelbert Patrick , Haggerty John , Portouw Steven
Published: December 2018

The case illustrates the diagnosis and treatment of a patient with swimming-induced pulmonary edema (SIPE), an uncommon cause of pulmonary edema in triathletes and military recruits. The pathophysiology is not completely understood but is thought to relate to the effects caused by immersion in conjunction with vigorous exertion. Diagnosis is by history and physical, with the prototypical SIPE patient being a previously healthy athlete exhibiting acute onset edema while exercising in the water. Typical symptoms and signs include shortness of breath, hypoxia, rales, and cough, which may or may not be productive with pink, frothy sputum. Radiographs may be obtained but are mainly obtained to rule out other diagnoses including pneumonia and pneumothorax. Treatment is supportive, although some evidence is mounting that shows decreasing rates of SIPE with prophylactic sildenafil.
Odontoid Fracture Type II
Authors: Tarazona Daniel , Vaccaro Alexander R.
Published: December 2018

Type II odontoid fracture is one of the most common cervical spine injuries, associated with significant morbidity. A thorough history and evaluation of diagnostic imaging is crucial to identify specific patient and injury factors that will assist with the treatment algorithm. The initial decision between operative and nonoperative management is made on the basis of careful consideration of the patient’s age, comorbidities, concomitant injuries, prior functional status, neurological status, and fracture morphology. This chapter describes various operative surgical treatments for odontoid fractures, including segmental fixation consisting of C1 lateral mass with either C2 pedicle or pars screws, anterior odontoid osteosynthesis, and C1–C2 transarticular screw fixation. A posterior approach with segmental fixation using C1–C2 lateral mass with C2 pars screw is reviewed with special attention to help avoid neurovascular complications. Postoperatively, patients should be monitor for signs of retropharyngeal hematoma, dysphagia, aspiration, vocal cord paralysis, and surgical site infections.
Invasive EEG in Cortical Dysplasia
Authors: Tassi Laura , Mai Roberto
Published: December 2018

Focal cortical dysplasias (FCDs) are among the most frequent causes of focal, drug-resistant epilepsy. Recently, a new histopathological international consensus classification recognized three different types of FCDs, encompassing various anatomo-electro-clinical characteristics, associated with diverse connotations of architectural disruption and cytological abnormalities. These exhibit dissimilar patterns of clinical onset, seizure frequency, cognitive and neurological impairment, neuroradiological aspects, cortical localization, EEG characteristics, and surgical outcome. In the presurgical workup, the presence, localization, and possibility of identifying the limits of an anatomical lesion strongly influence the choice of investigations. Consequently, in FCDs type II and III, in which the dysplasia (particularly in type IIb) or the associated lesion (type III) are unambiguously evident, invasive monitoring is not mandatory. In contrast, FCDs type I, and a fraction of type II (varying between from 10% to 50%) show no or minor abnormalities on neuroradiological investigations. Here, invasive recordings are usually necessary.
SEEG in Polymicrogyria: When and How?
Authors: Maillard Louis , Ramantani Georgia
Published: December 2018

Polymicrogyria (PMG) is one of the most common malformations of cortical development (MCDs), with epilepsy affecting most patients. PMG-related drug-resistant epilepsy patients can be considered for surgery in well-selected cases. In this context, a comprehensive presurgical evaluation, often including stereo electroencephalography, is warranted to accurately delineate the epileptogenic zone. The heterogeneity of intrinsic epileptogenicity in the PMG, together with the additional or predominant involvement of remote cortical areas, calls for a different strategy in PMG compared with other MCDs, one that is not predominantly MRI- but rather SEEG-oriented. Favourable results in terms of seizure freedom and antiepileptic drug cessation are feasible in a large proportion of patients with unilateral PMG. PMG extent should not exclude the possibility of epilepsy surgery. On the other hand, patients with hemispheric PMG can be excellent hemispherotomy candidates, particularly in the presence of contralateral hemiparesis. Recent findings support early consideration of surgery in PMG-related drug-resistant epilepsy.
Subdural EEG in Temporal Lobe Epilepsy
Authors: Schuele Stephan U.
Published: December 2018

Invasive extraoperative EEG using subdural grids and strip electrodes is indicated for well-selected patients with suspected temporal lobe epilepsy (TLE) to confirm and delineate the epileptogenic zone prior to resection. This chapter discusses indications, hypothesis, and strategy for implantation of subdural electrodes. The emphasis is on a practical approach, with patients with MRI-negative and MRI-positive TLE being discussed separately and with a number of illustrative cases being presented.
Invasive EEG Investigation of the Insula
Authors: Ryvlin Philippe , Picard Fabienne
Published: December 2018

Invasive EEG investigation of the insular cortex is performed in various forms of focal drug-resistant epilepsies, including patients with a clear-cut intra-insular epileptogenic lesion, such as focal cortical dysplasia, as well as patients whose non-invasive presurgical evaluation suggests perisylvian epilepsy, temporal plus epilepsy, sleep hypermotor epilepsy, or MRI-negative frontal or parietal lobe epilepsy. Stereo-EEG (SEEG) is currently the preferred method for investigating the insula, using orthogonal or oblique trajectories, or a combination, with no evidence of higher risk of intracranial bleeding than in other brain regions. Intra-insular ictal EEG patterns are often characterized by a prolonged focal discharge restricted to one of the five insular gyri, requiring dense sampling of the insular cortex in suspected insular epilepsies. SEEG also offers the potential to perform thermolesion of insular epileptogenic zones, which, together with MRI-guided laser ablation, represents a possibly safer alternative to open-skull surgical resection of the insula.
Dynamic Spectral Imaging: Online and Offline Functional Brain Mapping Using High-Frequency Activity [50–150 Hz] in SEEG
Authors: Lachaux Jean-Philippe
Published: December 2018

At the end of the twentieth century, a handful of research groups discovered that neural processing leaves a characteristic signature in intracranial EEG recordings: an increase of power in a broad frequency range above 50 Hz, dubbed ‘high-gamma’ of high-frequency activity ([50–150 Hz]). Since then, intracranial EEG research on human cognition has focused primarily on high-gamma activity to reveal the large-scale cortical dynamics of most major cognitive functions, not only offline in well-controlled paradigms, but also online, while patients freely interact with their environment. This chapter introduces that approach, including its recent extension to task-induced neural activity suppressions and functional connectivity mapping, and its clinical application to minimize cognitive deficits induced by epilepsy surgery.
Case 1.18
Authors: Lee Christine U. , Glockner James F.
Published: December 2018

45-year-old man with right-sided abdominal pain and multiple indeterminate liver masses initially detected on CT. Various pathologists had read the core biopsies obtained at a separate institution as “positive for malignancy,” “low-grade malignancy,” “benign liver tissue,” and “possible adenoma or atypical FNH”

Axial fat-suppressed FSE T2-weighted image (...
Case 1.23
Authors: Lee Christine U. , Glockner James F.
Published: December 2018

4-year-old boy with abdominal pain initially diagnosed as constipation. The pain worsened, and a CT demonstrated a hepatic mass

Coronal SSFSE (Figure 1.23.1) and axial fat-suppressed FSE T2-weighted (Figure 1.23.2) images reveal a large heterogeneous mass in the right hepatic lobe, with markedly increased signal intensity. Axial precontrast and arterial, portal venous, and equilibrium phase postgadolinium 3D SPGR images (...
Case 1.25
Authors: Lee Christine U. , Glockner James F.
Published: December 2018

68-year-old man with a history of hepatitis diagnosed 40 years ago and gradually worsening hepatic function, now with new lower-extremity swelling and ascites

Axial fat-suppressed T2-weighted image (Figure 1.25.1) demonstrates a cirrhotic liver with perihepatic ascites and a hypointense mass with a hyperintense inner nodule in the posterior medial right hepatic lobe. Axial T1-weighted 2D SPGR IP and OP images (...
Case 1.26
Authors: Lee Christine U. , Glockner James F.
Published: December 2018

83-year-old man with suspected HCC

Axial fat-suppressed FSE T2-weighted image (Figure 1.26.1) demonstrates a large mass in the anterior right hepatic lobe, with heterogeneous increased T2-signal intensity. Axial T1-weighted 2D SPGR IP and OP images (Figure 1.26.2) reveal no signal dropout within the mass on the OP image to suggest intravoxel fat. Axial postgadolinium (Eovist) arterial (...
Case 1.27
Authors: Lee Christine U. , Glockner James F.
Published: December 2018

75-year-old woman with a history of deep venous thrombosis and pulmonary emboli

Coronal SSFSE (Figure 1.27.1) and axial fat-suppressed FSE T2-weighted (Figure 1.27.2) images reveal a large exophytic mass projecting inferiorly from the right hepatic lobe, with a few scattered foci of mildly increased signal intensity. Axial diffusion-weighted image (b=400 s/mm...
Case 1.28
Authors: Lee Christine U. , Glockner James F.
Published: December 2018

20-year-old woman with epigastric pain, episodes of nausea and vomiting, and intermittent diarrhea

Axial fat-suppressed FSE T2-weighted (Figure 1.28.1) and diffusion-weighted (b=600 s/mm2) (Figure 1.28.2) images reveal a large heterogeneous mass involving the left and anterior right hepatic lobes, with regions of peripheral high signal intensity. Axial IP and OP T1-weighted 2D SPGR images (...
Case 1.30
Authors: Lee Christine U. , Glockner James F.
Published: December 2018

82-year-old man with vomiting, jaundice, and abnormal CT

Coronal SSFSE (Figure 1.30.1), axial fat-suppressed T2-weighted FSE (Figure 1.30.2), and axial diffusion-weighted (b=100 s/mm2) (Figure 1.30.3) images demonstrate a large mass in the central right hepatic lobe surrounding, but not occluding, the right hepatic veins. Axial arterial, portal venous, equilibrium, and delayed phase postgadolinium 3D SPGR images (...
Case 2.3
Authors: Lee Christine U. , Glockner James F.
Published: December 2018

42-year-old woman with alcoholic liver disease with new pain, weight loss, and elevated liver function levels; abdominal CT showed a suspicious hepatic mass

Axial fat-suppressed T2-weighted FSE (Figure 2.3.1) and fat-suppressed 2D SSFP (Figure 2.3.2) images demonstrate a nodular hepatic contour and underlying nodularity of the hepatic parenchyma with signal intensity slightly lower in the right hepatic lobe, as well as ascites. Axial T1-weighted IP and OP 2D SPGR images (...
Case 2.11
Authors: Lee Christine U. , Glockner James F.
Published: December 2018

45-year-old woman with acute myelogenous leukemia having undergone several chemotherapeutic regimens

Axial fat-suppressed FSE T2-weighted image (Figure 2.11.1) demonstrates several lobulated splenic masses and a more subtle lesion in the periphery of the right hepatic lobe. Axial IP and OP T1-weighted 2D SPGR (...
Case 2.12
Authors: Lee Christine U. , Glockner James F.
Published: December 2018

34-year-old woman with a systemic disorder

Coronal SSFSE (Figure 2.12.1), axial fat-suppressed T2-weighted FSE (Figure 2.12.2), and axial diffusion-weighted (b=100 s/mm2) (Figure 2.12.3) images demonstrate hepatomegaly with multiple small hyperintense nodules predominantly involving the left hepatic lobe. Axial arterial (...
Case 2.15
Authors: Lee Christine U. , Glockner James F.
Published: December 2018

55-year-old woman with epistaxis

Axial fat-suppressed T2-weighted FSE image (Figure 2.15.1) demonstrates subtle, ill-defined areas of intermediate increased signal throughout the liver that are more easily visualized on DWI (b=600 s/mm2) (Figure 2.15.2). Axial arterial, portal venous, equilibrium phase, and delayed hepatobiliary phase 3D SPGR images (...
Case 2.16
Authors: Lee Christine U. , Glockner James F.
Published: December 2018

83-year-old man being evaluated in the emergency department for abdominal pain

Axial postgadolinium portal venous phase images (Figure 2.16.1) demonstrate nearly occlusive thrombus throughout the main portal vein. Reformatted oblique images (Figure 2.16.2) show thrombus extension into the right and left portal veins and the superior mesenteric vein....
Case 2.25
Authors: Lee Christine U. , Glockner James F.
Published: December 2018

60-year-old woman with chronic liver disease

Axial diffusion-weighted image (b=100 s/mm2) (Figure 2.25.1) demonstrates a mildly irregular hepatic contour with parenchymal nodularity and a hyperintense lesion in the medial left lobe. The IP and OP T1-weighted 2D SPGR images (...
Case 2.30
Authors: Lee Christine U. , Glockner James F.
Published: December 2018

60-year-old woman with incidentally noted abnormal liver function tests

Axial fat-suppressed FSE T2-weighted (Figure 2.30.1) and axial IP and OP T1-weighted 2D SPGR (Figure 2.30.2) images demonstrate a cirrhotic configuration of the liver with enlargement of the left hepatic lobe and the caudate lobe (not entirely included here), as well as diffuse, innumerable small hypointense nodules that do not demonstrate appreciable dropout on IP and OP images. The nodules are not seen on the axial T1-weighted pregadolinium 3D SPGR image (...
Case 2.31
Authors: Lee Christine U. , Glockner James F.
Published: December 2018

53-year-old woman with chronic liver disease

Axial fat-suppressed 2D SSFP images (Figure 2.31.1) demonstrate a nodular cirrhotic liver with splenomegaly and enlarged patent umbilical veins. Subvolume MIP (Figure 2.31.2) and VR (Figure 2.31.3) images reconstructed from a portal venous phase postgadolinium 3D SPGR acquisition again demonstrate large paraumbilical varices....
Case 2.36
Authors: Lee Christine U. , Glockner James F.
Published: December 2018

74-year-old woman with painless jaundice

Coronal SSFSE (Figure 2.36.1), axial fat-suppressed T2-weighted FSE (Figure 2.36.2), and axial diffusion-weighted (b=600 s/mm2) (Figure 2.36.3) images demonstrate infiltrative soft tissue predominantly in the central periportal regions and extending along both right and left portal tracts into the liver. Arterial, portal venous, and equilibrium phase images (...
Case 2.38
Authors: Lee Christine U. , Glockner James F.
Published: December 2018

57-year-old man with known disease

Axial fat-suppressed FSE T2-weighted (Figure 2.38.1), and diffusion-weighted (b=100 s/mm2) (Figure 2.38.2) images demonstrate innumerable hyperintense lesions throughout the liver. Axial precontrast, arterial, portal venous, and equilibrium phase images (Figure 2.38.3) show that most of these lesions have intense arterial phase hyperenhancement and become isointense relative to liver on portal venous and equilibrium phase images. A few lesions have central necrosis; others show more gradual contrast enhancement....
Case 3.1
Authors: Lee Christine U. , Glockner James F.
Published: December 2018

51-year-old woman with severe right upper quadrant pain; US revealed focal, masslike mural thickening of the gallbladder with differential considerations including adenomyomatosis, gallbladder neoplasm, and cholecystitis

Coronal images from 3D SSFP acquisition (Figure 3.1.1) demonstrate heterogeneous gallbladder wall thickening interspersed with multiple small mural cysts. Volume-rendered images from the 3D SSFP acquisition (...
Case 3.2
Authors: Lee Christine U. , Glockner James F.
Published: December 2018

49-year-old man with a history of prior intrahepatic biliary stone disease and new onset of right upper quadrant pain

Coronal SSFSE (Figure 3.2.1) and axial fat-suppressed SSFP (Figure 3.2.2) images show moderate gallbladder wall thickening with mural edema and a gallstone in the gallbladder neck. Of note, a smaller stone, probably impacted in the cystic duct, and the bile fluid-fluid level can be seen on axial SSFP images. Axial postgadolinium 3D SPGR images (...
Case 3.7
Authors: Lee Christine U. , Glockner James F.
Published: December 2018

80-year-old man with right upper quadrant pain and elevated liver function tests; abdominal US performed at an outside institution showed a mass in the gallbladder

Arterial (Figure 3.7.1), portal venous (Figure 3.7.2), and equilibrium phase (Figure 3.7.3) postgadolinium 3D SPGR images demonstrate a hyperenhancing mass within the gallbladder lumen. Note also the large heterogeneous mass seen in the upper pole of the right kidney....
Case 3.10
Authors: Lee Christine U. , Glockner James F.
Published: December 2018

76-year-old woman status post liver transplant 5 years ago for cirrhosis secondary to hepatitis B

Volume-rendered image from 3D FRFSE MRCP (Figure 3.10.1) and coronal SSFSE image (Figure 3.10.2) demonstrate an abrupt high-grade stricture in the mid CBD at the site of biliary anastomosis. Note also the filling defect in the distal CBD on the SSFSE image....
Case 3.12
Authors: Lee Christine U. , Glockner James F.
Published: December 2018

19-year-old pregnant woman with a 2-week history of right upper quadrant pain

Coronal SSFSE (Figure 3.12.1) and axial T2-weighted FSE (Figure 3.12.2) images demonstrate massive dilatation of the CBD at the bifurcation, as well as the distal duct. Dilatation of perihilar intrahepatic ducts can be seen. Within the duct, there is a large filling defect or nodule, which is predominantly hypointense on the T2-weighted images and contains a central cystic region with a fluid-fluid level....
Case 3.17
Authors: Lee Christine U. , Glockner James F.
Published: December 2018

27-year-old man with ulcerative colitis and recent history of intermittent fever, chills, and dilated biliary ducts on CT

Axial T2-weighted FSE images (Figure 3.17.1) show diffuse soft tissue thickening in the hepatic hilum encasing the central biliary ducts. Note the mild peripheral intrahepatic biliary dilatation. Axial equilibrium phase 3D SPGR images (...