BACKGROUND: Cardiac magnetic resonance (CMR) plays a major diagnostic role in acute myocarditis (AM) in children as biopsy is rarely performed in this age group. Contribution of standard echocardiography (ECHO) is limited in AM, but speckle tracking echocardiography (STE) quantitatively characterizes myocardial function, with good sensitivity for detecting subclinical left ventricular (LV) dysfunction and regional kinetics disorders beyond the site of inflammation. This work aimed to evaluate the diagnostic potential of STE as compared with CMR findings in pediatric patients with AM. METHODS: The study was conducted during 2022-2023. Troponin, electrocardiography, ECHO with STE, and CMR with early and late enhancement were performed on each patient. Affected heart segments were analyzed by both STE and CMR, and the correlation of the two methods was assessed. RESULTS: During the study period, 20 children were diagnosed with AM [14 boys, 6 girls; mean age 12 years (median 14)]. On ECHO, three patients had a deviation in LV biometry, and four patients had a mild systolic function disorder. STE showed at least one affected cardiac segment in all patients, most often the inferolateral segment (16/20; 80%). Of the 20 patients, STE showed a reduction in LV global longitudinal strain in 13 (65%) patients. In all patients, CMR identified an inflammatory focus, most frequently inferolateral (15/20; 75%). The strongest accordance between STE and CMR was observed for the involvement of anterolateral segments (k = 0.88) and the weakest for inferoseptal damage (k = 0.4). CONCLUSIONS: STE can provide important diagnostic information in pediatric patients with AM. This modality supports the detection of early regional edema and subclinical myocardial dysfunction and can determine the impairment severity. STE is non-invasive and repeatable without the need for special patient preparation or for general anesthesia.
- Publikační typ
- časopisecké články MeSH
- Publikační typ
- abstrakt z konference MeSH
Detection of serum galactomannan (GM) and (1,3)-β-d-glucan (BG) is considered useful for non-culture diagnosis of invasive pulmonary aspergillosis (IPA) in neutropenic patients. Only few studies evaluated these seromarkers in non-neutropenic patients suspected of having IPA. The aim of this study was to evaluate both tests together with the Aspergillus fumigatus-specific serum IgG and IgA (IgAG) test for serological IPA diagnosis in non-neutropenic patients. Sera from 87 patients suspected of having IPA were retrospectively analysed. Patients were categorised into groups of proven IPA (n = 10), putative IPA (n = 31) and non-IPA colonisation (n = 46). When the GM, BG and IgAG assays were used for patients included in the study, the sensitivity/specificity/positive predictive value (PPV)/negative predictive value (NPV) were 48.8%/91.3%/83.3%/66.7%, 82.9%/73.9%/73.9%/82.9% and 75.6%/95.7%/93.9%/81.5%, respectively. Thus, the highest specificity and PPV were confirmed for the IgAG assay. Improvements in the sensitivity and NPV were achieved by "at least one positive" analysis with the GM and BG assays, with the sensitivity/specificity/PPV/NPV values being 85.0%/69.6%/71.4%/84.2%. Nevertheless, the highest sensitivity and NPV were achieved by the "at least one positive" analysis combining the GM, BG and IgAG tests (97.6% and 96.8%, respectively). The involvement of the IgAG assay could improve IPA diagnosis in non-neutropenic patients by increasing the sensitivity and NPV when combined with the GM or BG assays. Furthermore, improvement was achieved by combining the GM, BG and IgAG assays using the "at least one positive test" strategy, especially if doubt exists.
- MeSH
- Aspergillus fumigatus chemie imunologie MeSH
- beta-glukany krev MeSH
- dospělí MeSH
- imunoglobulin A krev MeSH
- imunoglobulin G krev MeSH
- invazivní plicní aspergilóza diagnóza MeSH
- lidé středního věku MeSH
- lidé MeSH
- mannany krev MeSH
- mladiství MeSH
- mladý dospělý MeSH
- prediktivní hodnota testů MeSH
- protilátky fungální krev MeSH
- retrospektivní studie MeSH
- senioři nad 80 let MeSH
- senioři MeSH
- senzitivita a specificita MeSH
- sérum chemie MeSH
- Check Tag
- dospělí MeSH
- lidé středního věku MeSH
- lidé MeSH
- mladiství MeSH
- mladý dospělý MeSH
- mužské pohlaví MeSH
- senioři nad 80 let MeSH
- senioři MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- hodnotící studie MeSH
- multicentrická studie MeSH
Úvod: Mechanická trombektomie je účinná metoda v léčbě akutního ischemického mozkového infarktu s prokázanou okluzí velké intrakraniální arterie. Hlavní indikační kritéria pro mechanickou trombektomii jsou akutní intrakraniální tepenná okluze a nerozsáhlé časné ischemické změny hodnocené pomocí ASPECT skóre ≥ 6 bodů. Cílem naší studie bylo porovnání shody v hodnocení časných ischemických změn pomocí ASPECT skóre mezi intervenčním neuroradiologem a všeobecným neurologem. Metodika: Do studie byli zařazeni všichni pacienti s ischemickou CMP přijatí do 12 h od vzniku potíží do Komplexního cerebrovaskulárního centra FN Ostrava od dubna do října 2015. Všem pacientům byla provedena nativní CT mozku, která byla retrospektivně hodnocena intervenčním neuroradiologem a všeobecným neurologem. Výsledky: Do studie bylo zařazeno 136 pacientů, z toho 71 žen, věk 71 ± 13 let, a 65 mužů, 68 ± 12 let. Celkem 64 (47 %) pacientů podstoupilo intravenózní trombolýzu, 33 (24 %) pacientů mechanickou trombektomii. Absolutní shoda v hodnocení ASPECT skóre byla 64 %, nevážený kappa index (κ) 0,19; 95 % CI 0,063–0,316. Shoda na 1–2 body v hodnocení ASPECT skóre 90 %; κ 0,19; 95 % CI 0,133–0,220. Shoda na 1–6 a 7–10 bodů v hodnocení ASPECT skóre 94 %; κ 0,40; 95 % CI 0,076–0,731. Závěr: V naší studii jsme prokázali mírnou až slabou shodu v hodnocení přítomnosti rozsáhlých časných ischemických změn mezi neurologem a intervenčním neuroradiologem.
Introduction: Mechanical thrombectomy is an effective method in the treatment of acute ischemic stroke with evidence of the occlusion of the large intracranial artery. The main indication criteria for mechanical thrombectomy are acute intracranial arterial occlusion and an ASPECT score ≥ 6 points. The aim of our study was to compare the evaluation of early ischemic changes using the ASPECT score between the interventional neuroradiologist and the general neurologist. Methods: All patients with ischemic stroke admitted within 12 h after the onset of the symptom to the Comprehensive Stroke Center, University Hospital Ostrava from April to October 2015 were enrolled in the study. All patients received a non-contrast brain CT examination which was retrospectively evaluated by the interventional neuroradiologist and the general neurologist. Results: 136 patients were included in the study; 71 women, age 71 ± 13 years and 65 men, age 68 ± 12 years. A total of 64 patients (47%) underwent IVT, and 33 patients (24%) had mechanical thrombectomy. An absolute match in the ASPECT score rating was 64%, unweighted kappa index (κ) was 0.19, and 95% CI was 0.063–0.316. Matching 1–2 points in ASPECT score rating was 90%; κ was 0.19; and 95% was CI 0.133–0.220. Matching 1–6 and 7–10 points in ASPECT score rating was 94%; κ was 0.40; and 95% CI was 0.076–0.731. Conclusion: In our study, we have shown a slight to fair agreement in assessing the presence of extensive early ischemic changes between the neurologist and the interventional neuroradiologist.
- Klíčová slova
- ASPECT skóre, časné ischemické změny,
- MeSH
- cévní mozková příhoda * diagnóza MeSH
- ischemie mozku diagnóza MeSH
- lidé středního věku MeSH
- lidé MeSH
- počítačová rentgenová tomografie metody MeSH
- retrospektivní studie MeSH
- senioři nad 80 let MeSH
- senioři MeSH
- stupeň závažnosti nemoci MeSH
- vyhodnocení orgánové dysfunkce MeSH
- Check Tag
- lidé středního věku MeSH
- lidé MeSH
- mužské pohlaví MeSH
- senioři nad 80 let MeSH
- senioři MeSH
- ženské pohlaví MeSH
PURPOSE: To determine the success rate of revision endoscopic dacryocystorhinostomies (DCR) and to analyse 44 revision DCRs. METHODS: The operative and postoperative data were collected in 44 revision DCRs. The corrections of associated structural anatomic alterations were performed during the surgery (resection of the scarr, the bone window creating, resection of the head of the middle turbinate, septoplasty, ethmoidectomy etc.) and the intubation was performed in all cases. RESULTS: The follow-up interval ranged from 12 to 36 months. The 44 ReEDCRs were performed in adults and there were only 5 children under the age of 15. The surgery was performed under local or general anaesthesia. The most frequent secondary procedures were scar resections, creating a wider bone window, and partial middle turbinate resection. Four patients were excluded for their follow-up periods had not been completed. An average time of the tubes removal was 5.6 months. The total success rate was 84.0%; the success rate was 85.7% in the group with closed rhinostomy and 1/2 in the group of canalicular and rhinostomy obstructions. CONCLUSIONS: The endonasal revision DCR is a safe and very effective surgical procedure following the failed DCRs. The correction of associated structural anatomic alterations that may be involved in the failure of previous surgeries can be easily performed.
- MeSH
- dakryocystorinostomie metody MeSH
- dítě MeSH
- endoskopie MeSH
- lidé středního věku MeSH
- lidé MeSH
- mladiství MeSH
- mladý dospělý MeSH
- reoperace MeSH
- retrospektivní studie MeSH
- senioři nad 80 let MeSH
- výsledek terapie MeSH
- Check Tag
- dítě MeSH
- lidé středního věku MeSH
- lidé MeSH
- mladiství MeSH
- mladý dospělý MeSH
- mužské pohlaví MeSH
- senioři nad 80 let MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
