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Objective: To investigate the utility of the Appendicitis Computed Tomography (ACT) scoring system in the diagnosis of perforated appendicitis and prediction of surgical outcome. Methods: A retrospective study was conducted on 102 subjects who underwent computed tomography (CT) scan and appendectomy for acute appendicitis between May 2011 and January 2012. Images were reviewed for five individual CT signs (appendiceal wall defect, phlegmon, abscess, extraluminal gas, and extraluminal appendicolith) and a score (ACT score) was assigned for each patient based on the number of detectable findings. Correlation of ACT score and individual CT signs with appendiceal perforation and surgical outcome was evaluated statistically. Diagnostic power was assessed using receiving operating characteristic (ROC) curve. Results: A total of 84 subjects were included in the final study after exclusion. ACT score was significantly higher for the perforated group compared with the non-perforated group (2.52 vs. 0.40, p < 0.001) and also higher for the open surgery group than the laparoscopic surgery group (2.78 vs. 0.93, p < 0.001). ACT score was an independent predictor of perforation (odds ratio [OR] = 7.05, p < 0.001), need for open surgery (OR = 2.99, p = 0.002), and operating time (increase of 12.93 minutes, p < 0.001). On ROC curves, ACT score showed a higher discriminating power for both appendiceal perforation (area under the curve [AUC] = 0.939) and need for open surgery (AUC = 0.858) than individual CT signs. An ACT score of 0 was 100% sensitive for excluding appendiceal perforation and open surgery in our study, whereas an ACT score of >3 was diagnostic for perforated appendix. Conclusions: The ACT score is a practical and accurate tool for diagnosis of appendiceal perforation and prediction of surgical outcome.

Objective: To describe the pattern of bronchostenosis revealed by computed tomography and virtual bronchoscopy in patients with active tuberculous endobronchitis and associated pulmonary manifestations. Methods: This retrospective study was conducted in Hong Kong, which is an endemic region for tuberculosis, where tuberculous endobronchitis remains a noteworthy clinical entity, with reported frequency of 10 to 40% in patients with active pulmonary tuberculosis. Medical records of a series of 18 patients with active endobronchial tuberculosis (without acquired immunodeficiency syndrome), having acid-fast bacilli in sputum smears, underwent computed tomography and virtual bronchoscopy in two regional hospitals between January 2007 and October 2009 were reviewed. The location, morphology, length, and percentage of luminal bronchostenotic narrowing were evaluated by such imaging and compared with fibre-optic bronchoscopy findings. Associated parenchymal manifestations, namely tree-in-bud nodules, cavitary lesions, segmental atelectasis and enlarged mediastinal lymph nodes, were assessed. Results: Involvement of tuberculous endobronchitis at a single major lobar bronchus with contiguous spread along ipsilateral bronchial tree was observed in most patients (n = 16, 89%). A mural cause of bronchostenosis remained the most frequent finding (n = 12, 67%), with irregular circumferential thickening predominating (n = 8, 44%). Regarding associated parenchymal manifestations, tree-in-bud nodules occurred in all patients (n = 18, 100%); cavitary lesions (n = 9, 50%) and segmental atelectasis (n = 7, 39%) were less frequent. Mediastinal lymph node enlargement was a rare finding (n = 3, 17%). Fibre-optic bronchoscopy performed during the same admission showed confirmatory results in all available cases (n = 14). Conclusion: Centripetal spread of tuberculous endobronchitis from distal small airways to proximal central airway was observed in the majority of our patients. This could correlate with probable pathogenic mechanisms including the submucosal lymphatic spread of tuberculous bacilli and the implantation of bacilli by infected sputum along the bronchial tree. Relative left-sided predominance of bronchial involvement was observed, possibly related to intrinsic anatomical difference in lymphatic drainage between left-and right-sided bronchi. Irregular circumferential and eccentric mural thickening was the most common morphological pattern of bronchostenosis with mural thickening. Mediastinal lymph node enlargement was rare.

Objectives: To evaluate the effectiveness of endovascular treatment (EVT) for acute ischaemic stroke in terms of angiographic results and clinical outcomes. Methods: Patients who presented with symptoms of acute ischaemic stroke and who underwent EVT including mechanical thrombectomy and/or intra-arterial thrombolysis (IAT) at an acute-care public hospital between January 2013 and October 2016 were recruited. Digital angiographic images were reviewed by an independent neuroradiologist, who assigned a Thrombolysis in Cerebral Infarction (TICI) grade to each patient. Medical records were reviewed to retrieve the National Institutes of Health Stroke Scale score, modified Rankin scale (mRS) score at 90 days, and clinical outcomes. Results: Records of a total of 38 patients were reviewed (mean age, 65.6 years). In all, 19 patients were treated with aspiration thrombectomy alone, 11 with both stent retriever and aspiration thrombectomy, six with stent-retriever thrombectomy alone, one with aspiration thrombectomy and IAT, and one with IAT alone. Revascularisation was successful (TICI grade 2b/3) in 76% of patients. The median time to reperfusion from the start of the procedure was 1 hour 3 minutes. Post-procedural symptomatic intracranial haemorrhage occurred in 11% of patients. Outcome was good (mRS score ≤ 2) and fair (mRS score ≤ 3) at 90 days in 27% and 43% of patients, respectively. The mean length of hospital stay for patients with successful and unsuccessful revascularisation was 35.7 and 62.3 days, respectively. The mortality rate within 90 days of EVT was 8%. Conclusion: Our study shows that EVT has a high success rate for recanalisation, overall patient clinical outcomes are acceptable, and the procedure-related complication and mortality rates are low.