This study aims to evaluate the overall prognosis, prognostic factors, and efficacy of treatment in patients with mesial temporal lobe epilepsy with hippocampal sclerosis (MTLE-HS) who have access to third generation anti-epileptic drugs but not to epilepsy surgery. Eighty-five MTLE-HS patients were retrospectively placed into a seizure-free (seizure-free for >1 year) or drug-resistant group, and the two groups were compared on the basis of age, sex, age at onset of seizures, duration of epilepsy, side of lesion, handedness, EEG findings, history of CNS infection, history of febrile convulsions, history of head trauma, history of cognitive impairment, family history of seizures, number of current anti-epileptic drugs (AEDs), total number of AED trials, and presence of individual AEDs. Only 24.7% of MTLE-HS patients had achieved seizure freedom for >1 year. Poor prognosis and drug-resistance were associated with younger age at onset of seizures (p=0.002), longer duration of epilepsy (p=0.018), greater number of current AEDs (p<0.001), and greater total number of AED trials (p<0.001). In addition, regimens with newer AEDs had no greater efficacy than regimens with older AEDs. Most medically managed MTLE-HS patients do not achieve seizure freedom despite multiple AED trials, and treatment with third generation AEDs should not preclude evaluation for epilepsy surgery.

Knowledge of the treatment-induced imaging abnormalities is essential in the accurate interpretation and diagnosis from the most routine to most challenging of clinical situations. We provide a pictorial review for the radiologist to employ in order to be an invaluable provider to our clinical colleagues and patients.

A 28-year-old man recently diagnosed with HIV (CD4 19 cells/mm, viral load 3.6 million copies/mL, not on highly active antiretroviral therapy on initial diagnosis at outside hospital), disseminated histoplasmosis, shingles and syphilis presented with paraplegia developing over 3 days. Spine MRI demonstrated a longitudinally extensive cord lesion extending from C3 to the tip of the conus. Brain MRI was consistent with meningoencephalitis. Cerebrospinal fluid findings were notable for positive varicella zoster virus (VZV) and cytomegalovirus (CMV) PCRs as well as a Venereal Disease Research Laboratory titre of 1:2. Patient was started on treatment for VZV and CMV meningoencephalitis, neurosyphilis and high-dose steroids for infectious myelitis. Repeat spine MRI demonstrated subacute intramedullary haemorrhage of the cervical cord. He was ultimately discharged to a skilled nursing facility for long-term intravenous antiviral therapy and rehabilitation. After 59 days in the hospital, his neurological exam remained grossly unchanged, with flaccid paraplegia and lack of sensation to fine touch in his lower extremities.

BACKGROUND: Management of surgical emergencies in spaceflight will pose a challenge as the era of exploration class missions dawns, requiring increased crew autonomy at a time when training and supplies will be limited. Ultrasound-guided percutaneous intervention would allow for the management of a variety of pathologies with largely shared equipment and training. This proof-of-concept work attempts to determine the feasibility of “just-in-time” remote teaching and guidance of a sample procedure of this type.METHODS: Subjects naïve to ultrasound-guided intervention were instructed via a short video regarding the technique for placement of a percutaneous drain into a simulated abscess within a gel phantom. Subjects were then guided through the performance of the procedure via two-way audiovisual communication with an experienced remote assistant. Technical success was determined by the successful aspiration or expression of fluid from the simulated abscess following drain placement. This was then performed by and compared with staff experienced with such procedures. Time to completion and number of needle redirections required were also measured.RESULTS: All 29 subjects naïve to interventional work and the 4 experienced control subjects achieved technical success. There was a statistically significant difference in the time to completion between the two groups, with the experienced subjects averaging 2 min to completion and the inexperienced 5.8 min. There was no statistically significant difference in the number of redirections.DISCUSSION: This proof-of-concept work demonstrates high rates of technical success of percutaneous ultrasound-guided intervention in previously inexperienced personnel when provided with brief just-in-time training and live two-way audiovisual guidance.Lerner DJ, Pohlen MS, Apland RC, Parivash SN. Just-in-time training with remote guidance for ultrasound-guided percutaneous intervention. Aerosp Med Hum Perform. 2022; 93(12):882–886.

Percutaneous biopsy of suspected liver metastases is a common practice for diagnostic purposes. Particularly, in the setting of oncological clinical trials, it is a relatively non-invasive method to obtain sufficient tissue for molecular analyses at regular set time points. However, various complications may occur, including seeding of the tumour along the biopsy tract. Only few reports exist on the actual incidence of seeding, on a limited number of tumor types. The aim of this study was to evaluate the technique's safety and risk of seeding. Materials: All patients with an ultrasound or CT-guided liver biopsy between 2012-2016 were included. Medical records were reviewed retrospectively for post-biopsy complications and all follow-up imaging was re-assessed for the presence of seeding, defined as tumoral deposits in the biopsy needle tract. Results: In total 782 biopsies were performed in 550 patients (282 women, 268 men; mean age of 61 years), 43.9% (343/782) for trials and 56.1% (439/782) for diagnostic/molecular purposes, 93.7% (733/782) were diagnostic, revealing malignancy in 96.9% (710/733). Number of biopsies per patient ranged between 1 (n ¼ 387) to 7 (n ¼ 1), a co-axial system was used in 70.6% (552/782) and multiple passes in 29.4% (230/782). Complications were reported in 8.8% (69/782), more often pain (4.7%) and hypotension/vasovagal (2.3%). Admission and/or re-intervention were needed for more severe complications as bleeding (1.0%), sepsis/ fever (1.1%), pulmonary embolism (0.3%) and pneumothorax (0.4%). Seeding was seen in 1.1% (8/782) of cases (2/44 melanoma, 1/11 GIST, 1/39 cholangiocarcinoma, 1/247 colorectal, 1/ 14 oesophagus, 1/97 breast, 1/31 prostate). Mean time for seeding was 208 days (range 43-469 d); mean post-biopsy survival time was 495 days in the seeding and 349 days in the non-seeding group. Conclusions: Percutaneous liver biopsy is a highly effective and safe method for tissue collection, with only a minimal risk of seeding.