bluuebunny/crossref_metadata_2025 huggingface dataset:
Malignant Diffuse Mesothelioma in Women
Authors: Pavlisko Elizabeth N. , Liu Beiyu , Green Cindy , Sporn Thomas A. , Roggli Victor L.
Published: December 2019

We reviewed 354 cases of malignant diffuse mesothelioma (MM) in women from a database of 2858 histologically confirmed MM cases. There was a pleural predominance with 78% pleural MM and 22% peritoneal MM. The pleural tumors consisted of 72% epithelioid, 19% biphasic, and 9% sarcomatoid variant. The peritoneal tumors consisted of 82% epithelioid, 13% biphasic, and 5% sarcomatoid. The immunohistochemical profile was typical of what is well-accepted and previously described for MM. When examining tumor subtype and location, there was a trend toward epithelioid subtype and peritoneal location; however, this did not reach statistical significance. Age at the time of diagnosis ranged from 19 to 93 years with a mean of 60 years. The median age at time of diagnosis for pleural MM was 65 years and for peritoneal MM was 52 years. A further look at age and histologic subtype showed no statistically significant difference in age between MM subtypes. Survival was greatest for epithelioid variant, and this was magnified in the peritoneum. A majority of our cases were exposed to asbestos through a household contact. Asbestosis and parietal pleural plaque were present in 5% and 50% of cases with data, respectively. Fiber analysis data was available in 67 cases; 38 cases had elevated asbestos fiber burden, and tremolite was the most common asbestos fiber type detected. Commercial and noncommercial amphibole asbestos fibers were elevated in nearly equal numbers of cases.
Clinicopathologic, Immunohistochemical, and Molecular Characteristics of Ovarian Serous Carcinoma With Mixed Morphologic Features of High-grade and Low-grade Serous Carcinoma
Authors: Zarei Shabnam , Wang Yan , Jenkins Sarah M. , Voss Jesse S. , Kerr Sarah E. , Bell Debra A.
Published: December 2019

Despite the current classification of high-grade serous carcinoma (HGSCA) and low-grade serous carcinoma (LGSCA) as mutually exclusive diseases based on morphology and molecular pathogenesis, cases with mixed morphologic features of HGSCA and LGSCA have been reported. Herein we assess the clinicopathologic, immunohistochemical (IHC), and molecular genetic characteristics of a group of these cases, which we termed indeterminate grade serous carcinoma (IGSCA) in comparison with groups of HGSCA and LGSCA. Using the World Health Organization (WHO) classification criteria, we selected 27 LGSCA and 19 IGSCA for detailed morphologic study. Thirteen classic HGSCA, 19 classic LGSCA, and 19 IGSCA were selected for p53 and BRAF V600E IHC and molecular genetic testing by next-generation sequencing. IGSCA showed the architectural patterns of invasion of LGSCA, but with higher grade nuclear features focally and a mitotic index intermediate between LGSCA and HGSCA. Few cases in the IGSCA group showed mutant TP53 by IHC or sequencing (4/18, 22.2%), 1 case had mutant BRAF non-V600E by sequencing, and 1 had an NRAS mutation. When present, the mutations were identical in the low-grade and high-grade areas. The IGSCA group had a long-term survival similar to the classic HGSCA group. IGSCA with mixed morphologic features of HGSCA and LGSCA is a rare and potentially clinically aggressive variant of serous carcinoma. Their distinct morphologic, but heterogenous molecular features, including low frequency of TP53 and BRAF mutations suggest that these rare tumors may have a different pathogenesis pathway compared with classic HGSCA and classic LGSCA.
IDH2 Mutation Analysis in Undifferentiated and Poorly Differentiated Sinonasal Carcinomas for Diagnosis and Clinical Management
Authors: Riobello Cristina , López-Hernández Alejandro , Cabal Virginia N. , García-Marín Rocío , Suárez-Fernández Laura , Sánchez-Fernández Paula , Vivanco Blanca , Blanco Verónica , López Fernando , Franchi Alessandro , Llorente José L. , Hermsen Mario A.
Published: December 2019

A large number of tumor types arise from the mucosa of the sinonasal cavities. Although presenting clinically distinct behavior, due to poorly differentiated histologic features, they can be difficult to classify correctly. Our aim was to investigate whether IDH2 and IDH1 mutations may be specific to a subset of undifferentiated and poorly differentiated sinonasal carcinomas. A total of 125 tumor samples of 7 different histologic subtypes were analyzed for IDH mutations by sequencing and mutant-specific immunohistochemistry, and the results were correlated to clinical and follow-up data. The highest incidence of IDH2 mutations occurred in sinonasal undifferentiated carcinoma, with 11/36 (31%) cases affected. However, also, 1/9 neuroendocrine carcinomas, 2/4 high-grade non–intestinal-type adenocarcinomas, and 1/8 poorly differentiated squamous cell carcinomas carried the IDH2 mutation, whereas 1/48 intestinal-type adenocarcinomas harbored an IDH1 mutation. Immunohistochemical analysis of mutant IDH1/2 produced a number of false-negative results, but also 1 false-positive tumor was found. Disease-specific survival was more favorable in IDH2-mutant versus wild-type cases. Our data suggest that IDH-mutant sinonasal cancers, independent of their histologic subtype, may represent a distinct tumor entity with less aggressive clinical behavior. Clinically, patients with these mutations may benefit from specific IDH-guided therapies.
Prospective Study of Doppler Ultrasound Surveillance for Deep Venous Thromboses in 1000 Plastic Surgery Outpatients
Authors: Swanson Eric
Published: December 2019

Background:

Current guidelines recommend individual risk stratification, chemoprophylaxis, and risk mitigation to prevent venous thromboembolism. However, the evidence for efficacy is lacking in plastic surgery outpatients. Anticoagulation can cause bleeding. Ultrasound technology offers a highly accurate screening method.

Methods:

A prospective study was undertaken among 1000 consecutive cosmetic surgery outpatients who were scanned at three times: before surgery, the day after surgery, and 1 week after surgery (inclusion rate, 93 percent). Intravenous sedation was used, with no muscle relaxation. Compression, Doppler color flow, and waveform analysis were performed on the deep veins of the lower extremities, including the calves. Affected patients were followed with weekly scans. No chemoprophylaxis was ordered. Sequential compression devices were used during the first half of the study.

Results:

Nine deep venous thromboses were detected (0.9 percent). Two thromboses were found on scans performed the day after surgery. Six thromboses were detected on the scan approximately 1 week after surgery. One deep venous thrombosis was detected 35 days after surgery. Eight of the nine patients were prescribed oral anticoagulants. All affected patients recovered fully. The mean time to thrombosis resolution was 4.8 weeks. A logistic regression found no deep venous thrombosis risk reduction from sequential compression devices. Patient age was significantly associated with deep venous thromboses (p < 0.05).

Conclusions:

Ultrasound surveillance offers an effective method for early detection and treatment of postoperative deep venous thromboses. This technology offers an alternative to risk stratification and chemoprophylaxis, which causes iatrogenic bleeding. Sequential compression devices are unnecessary for plastic surgery outpatients undergoing total intravenous anesthesia.

CLINICAL QUESTION/LEVEL OF EVIDENCE:

Diagnostic, IV.
The Utility of Preoperative Venous Testing for Lower Extremity Flap Planning in Patients with Lower Extremity Wounds
Authors: Janhofer David E. , Lakhiani Chrisovalantis , Kim Paul J. , Naz Iram , Black Cara K. , Tefera Eshetu A. , Akbari Cameron , Hashmi Amreen , Attinger Christopher E. , Evans Karen Kim
Published: December 2019

Background:

Although venous thrombosis is a leading cause of flap failure, the majority of lower extremity free flap planning is centered on arterial system evaluation. Preoperative identification of relevant abnormality in lower extremity venous systems by means of duplex ultrasound may aid in the diagnosis of clinically important abnormality that could affect lower extremity flap outcomes.

Methods:

Between November of 2014 and August of 2017, 57 patients underwent preoperative lower extremity venous duplex imaging and free tissue transfer for lower extremity wounds. A retrospective review was performed to describe lower extremity venous pathologic findings, relevant patient demographic data, comorbid conditions, and outcomes. Discovery of venous abnormality helped guide recipient vein selection.

Results:

Fifty-seven consecutive patients underwent 59 free flap operations to treat chronic lower extremity wounds. Venous duplex ultrasonography detected venous insufficiency (defined as >0.5 second of reflux) in 23 patients (39.0 percent), including 16 (27.2 percent) with deep thigh reflux, six (10.2 percent) with superficial calf reflux, and four (6.78 percent) with deep calf reflux. Deep venous thrombosis was found in four patients (6.78 percent) and treated with anticoagulation. The flap success rate was 98.3 percent. Five patients (8.47 percent) progressed to amputation. At a mean follow-up time of 15.1 ± 9.51 months (range, 1.67 to 35.2 months), 53 patients (89.8 percent) were able to continue community ambulation.

Conclusions:

Lower extremity venous duplex testing before free tissue transfer may be useful for optimizing flap recipient vessel selection and for detecting potentially unknown venous abnormality. Development of free flap planning protocols incorporating preoperative vascular imaging is important to achieving good functional outcomes in this comorbid patient population.

CLINICAL QUESTION/LEVEL OF EVIDENCE:

Diagnostic, IV.
Discrepancies in Parent Perceptions and Patient-Reported Psychosocial Function in Children with Craniofacial Anomalies
Authors: Volpicelli Elizabeth J. , Pfaff Miles J. , Potemra Hi’ilani M. K. , De Leon Fransia S. , Lin Johnny , Ayeroff Julia R. , Bradley James P. , Wilson Libby , Lee Justine C.
Published: December 2019

Background:

Understanding and optimizing psychosocial functioning in children with craniofacial anomalies are essential components of their reconstructive care. This work compared parental perceptions to pediatric self-reported psychosocial functioning in children with craniofacial anomalies.

Methods:

Two hundred twenty-one children with craniofacial anomalies (aged 8 to 17 years) and their parents were prospectively evaluated at two institutions using the parent-proxy and pediatric Patient-Reported Outcomes Measurement Information System to assess anger, anxiety, depression, and peer relationships. Children were stratified into three age groups: group A, 8 to 10 years; group B, 11 to 13 years; and group C, 14 to 17 years. Pearson correlations, analyses of variance with post hoc comparisons under the Tukey criterion, and paired samples t tests were performed.

Results:

When stratified by age, no correlations between parent and child reports were found in anxiety for group A and anger, anxiety, and peer relationships for group C. Whereas group A reported the worst psychosocial functioning, group C parents perceived their children to have the worst psychosocial functioning. Group A parents perceived lower depression and better peer relationships, whereas group C parents perceived higher anxiety and depression compared to self-reports.

Conclusions:

Parents perceived an inverse relationship between age and psychosocial functioning compared to self-reports by children with craniofacial anomalies. These discrepancies in the current work highlight the importance of child self-report and suggest incorporating longitudinal patient-reported and parent-proxy–reported outcomes measures for psychosocial functioning as part of standard clinical care for patients with craniofacial anomalies.
Concurrent Platysmaplasty and Genioplasty Using a Novel Intraoral Approach
Authors: Wu Robin T. , Timberlake Andrew T. , Bruckman Karl C. , Steinbacher Derek
Published: December 2019

Facial aging patients frequently seek improved neck and jawline definition. Microgenia, or lack of chin support, is often overlooked or underdiagnosed in these patients. The authors propose a simultaneous genioplasty, in addition to platysmaplasty and face/neck lift, to address both soft-tissue and bony components, and enhance the cervicomental area. The platysmaplasty is performed in a novel fashion using the intraoral genioplasty incision. The operative sequence includes intraoral incision, platysmal exposure, fat excision, platysmal tightening, genioplasty osteotomy/fixation, and external skin redraping (face/neck lift). Case examples are shown to illustrate appropriate candidate selection and results. Parameters for success include increased chin-throat distance and definition, improved cervicomental angle, and soft-tissue rejuvenation. The novel approach the authors describe enables discrete access to the platysmal and submental region and provides bony definition to help optimize the soft-tissue drape and definition.

CLINICAL QUESTION/LEVEL OF EVIDENCE:

Therapeutic, V.
Implication of Location of the Ascending Mental Artery at the Chin Injection Point
Authors: Tansatit Tanvaa , Phumyoo Thirawass , Sawatwong Worapat , McCabe Hannah , Jitaree Benrita
Published: December 2019

Background:

Facial proportions can be improved by means of chin augmentation in patients with a receding chin. The ascending mental artery is the main arterial supply to the top of the chin, and arterial occlusion of this artery can result in soft-tissue infarction. This study aims to measure the topographic anatomy of the ascending mental artery at the chin injection area, using a three-dimensional camera.

Methods:

Thirty-one embalmed cadaveric faces were dissected at the chin. The midline of the inferior margin of the mandibular protuberance was marked with a pin. A variation in size between the two opposite ascending mental arteries was noticed. The depth of the artery from the skin surface and distance from the midline were measured using a three-dimensional camera.

Results:

There were 19 dominant ascending mental arteries on the right and 12 on the left. The dominant ascending mental arteries enter the chin paracentrally, approximately 6 mm (mean ± SD, 5.64 ± 4.34 mm) from the midline, within the muscular plane, and at a depth of 4.15 ± 1.95 mm from the skin. Furthermore, the artery formed an anastomosis with the sublingual artery, within the floor of the mouth.

Conclusion:

Every aesthetic physician should recognize the course of the ascending mental artery and use the appropriate techniques to avoid vascular injury during chin augmentation using filler injections.
A Nipple-Areola Stencil for Three-Dimensional Tattooing: Nipple by Number
Authors: Azouz Solomon , Swanson Marco , Omarkhil Mirwais , Rebecca Alanna
Published: December 2019

Medical tattooing is a critical reconstructive component in women following mastectomy. Recently, novel three-dimensional tattooing techniques mimicking depth by using light and shadow principles have allowed for aesthetically superior results. However, results are variable between providers, and professionals skilled in tattooing are often inaccessible to patients. To assess the need and obtain more background information regarding current practices, the authors recorded survey results from 753 plastic and reconstructive surgery offices. Results showed that 23 percent of facilities that offer reconstruction do not perform or refer for nipple-areola complex tattooing, leaving the patients to seek the service on their own. In this article, the authors present the nipple-by-number device, a three-dimensionally–printed stencil to ensure an accurate, consistent, and personalized aesthetic result during three-dimensional nipple-areola complex tattooing. The nipple-by-number device permits the plastic surgeon or supervised treating specialist to inexpensively, efficiently, and expeditiously perform the three-dimensional nipple-areola complex tattooing in their office. Furthermore, the device gives the patients the option of having their premorbid nipple-areola complex anatomy restored through preoperative photographs or choosing a different nipple-areola complex from a catalogue of designs. The device can be applied on any reconstructed breast mound whether or not a nipple projection procedure has been performed.
Refining Indications for the Supercharge End-to-Side Anterior Interosseous to Ulnar Motor Nerve Transfer in Cubital Tunnel Syndrome
Authors: Power Hollie A. , Kahn Lorna C. , Patterson Megan M. , Yee Andrew , Moore Amy M. , Mackinnon Susan E.
Published: December 2019

The supercharge end-to-side anterior interosseous to ulnar motor nerve transfer has gained popularity over the past decade as a method of augmenting intrinsic muscle reinnervation in patients with acute neurotmetic ulnar nerve injuries. Controversy remains regarding its efficacy and appropriate clinical indications in cubital tunnel syndrome, where the timing of onset of axonal loss is less clear. The authors present guidelines for patient selection, surgical technique, and postoperative rehabilitation based on their clinical experience with the technique in this patient population.

CLINICAL QUESTION/LEVEL OF EVIDENCE:

Therapeutic, V.
Quality and Safety in Healthcare, Part LVIII
Authors: Harolds Jay A.
Published: December 2019

In the past, many articles focused on one or several interventions to prevent physician burnout, but increasingly, articles now focus on comprehensive programs to not only decrease burnout, but also to promote physician happiness and wellness. These programs include measuring burnout and joy in the workplace, promoting workplace safety and wellness activities, career assistance, optimizing compensation, increasing the respect shown to individuals and their teams, and coordination of the goals between the individual, the teams, and the organization.
Quality and Safety in Healthcare, Part LX
Authors: Harolds Jay A.
Published: December 2019

Improving the culture of the community the physician encounters at work is very important to combat burnout and improve joyfulness and wellness. This includes better relationships between doctors, and between doctors and other healthcare professionals and administrators. Engaging the physicians in their clinical work and other meaningful activities such as research, teaching, and important administrative activities is also important. Wellness in its broadest sense is not merely the absence of burnout or other maladies; it is also about achieving the individual's full potential for a successful life.
“Eye-Black” Sign Secondary to Nivolumab Immunotherapy
Authors: Priya Sarv , Graham Michael
Published: December 2019

A 54-year-old woman with known chest wall melanoma (post–wide local excision) presented for imaging after a yearlong therapy with nivolumab. 18F-FDG PET/CT was performed 1 day after she completed the immunotherapy. Maximum intensity projection images showed bilateral relatively symmetrical uptake in the facial region. On fused PET/CT images, the uptake was seen corresponding to subcutaneous malar prominence underneath the orbits (like eye-black stripe used in sports) with subcutaneous malar calcification. Repeat PET/CT performed after 3 months revealed significant decrease in the malar uptake. Interval resolution of the uptake likely suggested this being inflammatory and secondary to immunotherapy.
Simultaneous Time-of-Flight PET/MR Identifies the Hepatic 90Y-Resin Distribution After Radioembolization
Authors: Ting Chien-Hsin , Lin Ko-Han , Chiu Chuang-Hsin , Lee Rheun-Chuan , Huang Wen-Sheng
Published: December 2019

A 61-year-old woman with multiple hepatic metastases from uterus cervical cancer received 90Y radioembolization. The simultaneous time-of-flight (TOF) PET/MR clearly identified the untreated tumor parts on the posttherapeutic 90Y internal pair-production imaging. After another boosted 90Y injection, the metastatic hepatic tumors were well covered. The follow-up PET/MR revealed tumor shrinkage. The one-stop-shop TOF PET/MR provided useful follow-up information in patients receiving 90Y radioembolization.
Infected Mediastinal Bronchogenic Cyst Mimicking Malignancy on FDG PET/CT
Authors: Zhang Jun , Ni Yiming , Dong Aisheng
Published: December 2019

A 51-year-old man presented with cough and pain in his upper chest for 1 week. Chest CT showed an ill-defined right paratracheal mass with slight enhancement in the upper mediastinum. A FDG PET/CT was performed showing focal increased FDG uptake with SUVmax of 4.7 in the mass. The mass was excised surgically. Histopathologic examination revealed infected bronchogenic cyst.
Lymphoma Recurrence Along the Lymphatic Tract on 18F-FDG PET/CT Presenting as Lower Limb Swelling
Authors: Sabiq Sawsan , Tham Wei Ying , Sinha Arvind Kumar , Loi Hoi Yin
Published: December 2019

A 66-year-old woman with a known history of diffuse large B-cell lymphoma presented with left lower limb swelling following recent long-distance air travel. Ultrasound Doppler showed no evidence of deep vein thrombosis. In view of her medical history, an 18F-FDG PET/CT was ordered that found a soft tissue mass following the course of the femoral neurovascular bundle along the anteromedial aspect of the left thigh down to the popliteal fossa and the lateral calf muscle. This was confirmed to be tumor recurrence.
A Moving Meckel Diverticulum on 99mTc-Pertechnetate Imaging in a Patient With Inguinal Hernia
Authors: Zhang Yuan , Yang Pei-qing , Li Shun , Cai Xiao-jia , Yang Shang-xu
Published: December 2019

A boy aged 1 year 8 months underwent 99mTc-pertechnetate scintigraphy to evaluate the cause of bloody stool. On the initial images, there was an abnormal activity in the right abdomen, which changed location to the right groin in later images. A Meckel diverticulum was identified by histopathology examination. We concluded this case of moving Meckel diverticulum was caused by the synergy between an inguinal hernia and high abdominal pressure.
FDG PET/CT of Primary Ewing Sarcoma of IVC
Authors: Bedmutha Akshay Sharad , Puranik Ameya , Purandare Nilendu , Agrawal Archi , Shah Sneha , Suthar Ritesh R. , Rangarajan Venkatesh
Published: December 2019

Secondary involvement of inferior vena cava is a common presentation in aggressive solid malignancies, especially arising from kidneys, adrenals, and hepatobiliary system, mostly resulting from local infiltration. Rarely, primary tumors are seen arising from vascular tissue. The Ewing family of tumors commonly arises from bone, but there is a high propensity of these tumors to originate from nonosseous sites of mesenchymal cell origin. We would herewith demonstrate a rare presentation of Ewing sarcoma, seen originating from inferior vena cava, presenting as extensive intravascular tumor thrombosis, evaluated on FDG PET/CT imaging in a 12-year-old girl.
Prognostic Value of Baseline Total Metabolic Tumor Volume Measured on FDG PET in Patients With Richter Syndrome
Authors: Pontoizeau Clémence , Girard Antoine , Mesbah Habiba , Haumont Laure-Anne , Devillers Anne , Tempescul Adrian , Salaün Pierre-Yves , Lamy Thierry , Le Jeune Florence , Palard-Novello Xavier
Published: December 2019

Purpose

We evaluated the prognostic value of baseline total metabolic tumor volume (TMTV) measured using pretreatment FDG PET for patients with transformation of chronic lymphocytic leukemia (CLL) into diffuse large B-cell lymphoma (DLBCL).

Methods

A total of 28 patients with transformation of CLL into DLBCL who had undergone FDG PET before treatment were retrospectively reviewed. Univariate and multivariate analysis of conventional clinicopathologic variables (sex, age, World Health Organization performance status score, International Prognostic Index score, Binet stage, lactate dehydrogenase serum level [LDH], platelet count, presence or not of prior therapies for CLL, the time from CLL to Richter syndrome, Ann Arbor stage, Bulky or not) and metabolic parameters (SUVmax, SUVmean, TMTV, and total lesion glycolysis) at the time of the transformation of CLL into DLBCL were tested for overall survival (OS).

Results

Of the 28 patients, 14 patients (50%) died during the follow-up period. Low platelet count, World Health Organization performance status score >1, high LDH, and high TMTV were found to be significant prognostic factors for OS on univariate analysis. The 5-year estimates of OS were 63% in the low metabolic burden group (TMTV ≤1200 cm3) and 0% in the high metabolic burden group (TMTV >1200 cm3). Multivariate analysis revealed that only high LDH was a significant predictor after adjustment for other variables of OS.

Conclusions

TMTV extracted from FDG PET at the time of the transformation of CLL into DLBCL is a predictor of OS.
Complete Metabolic Response Assessed by FDG PET/CT to Paclitaxel-Ramucirumab in Patients With Metastatic Gastroesophageal Junction Cancer
Authors: Amrane Karim , Querellou Solène , Schick Ulrike , Abgral Ronan , Metges Jean-Philippe
Published: December 2019

Paclitaxel-ramucirumab chemotherapy is indicated in second line of metastatic gastroesophageal junction cancer (mGEJC) after progression under platinum–5-FU chemotherapy. Nevertheless, the reported common response after treatment is only partial within series. To date, only 1 case report of negative posttreatment FDG PET/CT was published without baseline examination from RAINBOW trial. We illustrated the interest of FDG PET/CT to evaluate treatment especially paclitaxel-ramucirumab with 2 examples of complete metabolic responses in 2 patients having different HER2 biomarker profiles of mGEJC. As illustrated, FDG PET/CT emerges as a useful approach for therapeutic assessment of targeted drugs in mGEJC.
68Ga–Prostate-Specific Membrane Antigen 11 PET/CT Detects Residual Glioblastoma After Radical Surgery in a Patient With Synchronous Recurrent Prostate Cancer
Authors: Pilati Emanuela , Nicolotti Daniele Giovanni , Ceci Francesco , Finessi Monica , Cerio Ivan , Dionisi Beatrice , Zotta Michela , Bellò Marilena , Deandreis Désirée
Published: December 2019

Prostate-specific membrane antigen (PSMA) is a transmembrane enzyme also known as folate hydrolase 1 highly expressed by prostate cancer (PCa) cells. However, PSMA overexpression by tumor-associated neovasculature of a variety of solid tumors, including glioblastoma (GBM), has also been proven. This clinical case reports about a 67-year-old man with a history of PCa who underwent radical surgery for GBM and performed a 68Ga-PSMA-11 PET/CT to restage PCa. PET imaging showed PSMA uptake in GBM residual disease after surgery. This finding suggests a possible role of PSMA inhibitors as diagnostic and therapeutic agents in patients affected by GBM.
Quality and Safety in Healthcare, Part LXI
Authors: Harolds Jay A.
Published: December 2019

Some of the causes for resident burnout and other impairments of wellness are the same as for other physicians, but some are quite different. For example, residents have much less autonomy and control, are under more pressure to learn a huge amount of information quickly, are more frequently evaluated, have stress from taking more examinations, and have more financial pressure than a typical physician who has graduated from formal training. Residency education also involves oversight from the Accreditation Council of Graduate Medical Education, which seeks to decrease some of the pressures of residency, but an unintended consequence of their limitation of work hours has been, in some programs, the phenomenon of “work compression.”
FDG PET/CT Findings of Ectopic Pituitary Adenoma
Authors: Ishizaki Umiko , Abe Koichiro , Takako Kamio , Masui Kenta , Sakai Shuji
Published: December 2019

A 72-year-old woman had undergone a right mastectomy for breast cancer 3 years earlier. PET/CT revealed a tumor with bony destruction of the skull base and FDG accumulation (SUVmax, 7.86). MRI showed the well-circumscribed tumor in the sphenoid sinus. The possibility of bone metastasis could not be denied. Tumor removal surgery was performed; the tumor was separate from the normal pituitary gland, and an ACTH-producing ectopic pituitary adenoma was diagnosed pathologically.
Ovarian Metastasis as Initial Presentation of Pancreatic Carcinoma on FDG PET/CT
Authors: Hou Guozhu , Jiang Yuanyuan , Li Fang , Cheng Xin
Published: December 2019

Pancreatic carcinoma metastasizing to the ovary is rare. We report the case of a 69-year-old woman with ovarian metastasis as initial presentation. Ultrasonography revealed a multicystic mass in the right adnexa, which was considered a malignancy. FDG PET/CT performed to detect possible metastasis revealed a right adnexal mass with mild activity and an additional FDG focus in the tail of the pancreas, which later proved to be ovarian metastasis from pancreatic carcinoma.
The Detection of Cardiac Adrenocorticotropic Hormone–Secreting Neuroendocrine Tumor With the Help of 68Ga-DOTATATE PET/CT
Authors: Hou Guozhu , Jiang Yuanyuan , Cheng Xin
Published: December 2019

Ectopic adrenocorticotropic hormone Cushing syndrome is a relatively rare condition. We present the case of a 39-year-old man with ectopic adrenocorticotropic hormone Cushing syndrome due to a cardiac neuroendocrine tumor (NET), which was localized with the help of 68Ga-DOTATATE. 18F-FDG PET/CT revealed a hypermetabolic lesion in the heart, while the distinction between physiological and pathological FDG uptake is difficult. 68Ga-DOTATATE PET/CT revealed focal uptake corresponding to the cardiac focus found on FDG PET/CT, providing evidence of cardiac NET. This case illustrates that 68Ga-DOTATATE could play a role in the evaluation of cardiac NET as it lacks significant physiological myocardial uptake.
FDG PET/CT of a Supraclavicular Silicone Granuloma at Follow-up of a Breast Carcinoma
Authors: Phan Sy Olivier , Rouchy René-Charles , De Leiris Nicolas , Nika Eleni , Djaileb Loïc
Published: December 2019

We report herein the case of a 33-year-old woman who was referred for FDG PET/CT staging prior to pregnancy after a 4-year lost to follow-up for a breast invasive ductal carcinoma (pT2N1 SBRII). FDG PET/CT revealed right supraclavicular lymphadenopathy potentially caused by breast carcinoma recurrence. No additional site was involved. Supraclavicular ultrasonography showed typical “snowstorm” appearance. MRI revealed signs of breast implant intracapsular rupture and signal intensity of silicone within a supraclavicular node. Fine-needle aspiration and microbiopsy of adenopathy finally confirmed silicone granuloma and ruled out breast cancer recurrence.
Extracranial Metastases From Glioblastoma With Primitive Neuronal Components on FDG PET/CT
Authors: Kay Matthew D. , Pariury Holly E. , Perry Arie , Winegar Blair A. , Kuo Phillip H.
Published: December 2019

A 17-year-old girl with World Health Organization grade IV glioblastoma with primitive neuronal components (histone H3 G34-mutant and IDH1 wild type) underwent whole-body FDG PET/CT staging due to vertebral metastases on initial MRI. PET/CT revealed extracranial metastatic disease with spinal leptomeningeal dissemination, osseous metastases, and peritoneal seeding via a ventriculoperitoneal shunt. Glioblastoma is uncommon in pediatric patients and particularly those with primitive neuronal components. Extracranial metastases from glioblastoma are more common in those with primitive neuronal components. This case demonstrates the utility of FDG PET/CT for revealing distant metastases from glioblastoma.
18F-FDG PET/CT of Benign Tracheal Glomus Tumor
Authors: Shao Dan , Gao Qiang , Wang Siyun , Cheng You , Wang Shuxia
Published: December 2019

Glomus tumors are tumors that arise from the glomus bodies, which can be found in sites of arteriovenous anastomosis. Glomus tumors can occur in all parts of the body but rarely occur in the trachea. The PET/CT findings of these tumors are similar to those of malignant tracheal tumors. We reported the PET/CT findings of a pathologically proven primary glomus tumor in the trachea of a 41-year-old man.
18F-FDG Uptake of Localized Malignant Peritoneal Mesothelioma
Authors: Kodama Eriko , Kodama Toshiki , Ichikawa Tamaki , Ikoma Haruka , Hashimoto Jun
Published: December 2019

We present 2 cases of malignant peritoneal mesothelioma (MPM) characterized by a localized solid mass without ascites and showing 18F-FDG uptake. A 79-year-old man with a history of asbestos exposure suffered from an epithelioid MPM originating from the hepatoduodenal ligament with FDG uptake (SUVmax 16.8). Another 80-year-old man with esophageal cancer showed desmoplastic MPM of the small bowel mesentery with FDG uptake (SUVmax 4.0). Desmoplastic MPM is more aggressive and yields poorer prognosis compared with the epithelioid type. However, the present desmoplastic MPM case showed mild FDG uptake because of rich fibrosis.
18F-FDG PET in Giant Cell Arteritis
Authors: Ahmadi Bidakhvidi Niloefar , Goffin Karolien , Van Laere Koen , Gheysens Olivier , Blockmans Daniel
Published: December 2019

An 87-year-old man, without significant history, presented at the emergency department with recurrent episodes of fever and weight loss for several weeks without diagnosis, despite extensive routine investigations including conventional imaging. 18F-FDG PET/CT revealed strongly increased uptake in the peripheral vessels of the upper and lower limbs with relative sparing of the larger vessels. Temporal artery biopsy was positive for arteritis. The diagnosis of giant cell arteritis with mainly involvement of upper and lower limbs was made, and treatment with high-dose oral methylprednisolone was started, resulting in a rapid clinical and biochemical improvement.
An Uncommon Initial Presentation of T-Cell/Histiocyte-Rich B-Cell Lymphoma
Authors: Filizoglu Nuh , Ones Tunc , Ozguven Salih , Turoglu Halil Turgut , Erdil Tanju Yusuf
Published: December 2019

T-cell/histiocyte-rich B-cell lymphoma accounts for approximately 1% to 3% of all cases of diffuse large B-cell lymphoma, and involvement of the kidneys comprises a mere 1% of the total primary extranodal lymphomas. We present a case of T-cell/histiocyte-rich B-cell lymphoma who had acute renal failure at initial presentation with bilateral lymphomatous infiltration depicted on FDG PET/CT scan. Four months after the treatment, a repeat FDG PET/CT scan revealed complete resolution of the renal lesions, indicative of the complete remission for kidneys.
The Relationship Between the Number of Ports and Surgical Outcomes in Laparoscopic Hepatectomy
Authors: Inoue Yoshihiro , Kitada Kazuya , Fujii Kensuke , Kagota Syuji , Tomioka Atsushi , Yamaguchi Toshifumi , Yokohama Keisuke , Ohama Hideko , Hamamoto Hiroki , Ishii Masatsugu , Osumi Wataru , Tsuchimoto Yusuke , Terazawa Tetsuji , Ogura Takeshi , Masubuchi Shinsuke , Yamamoto Masashi , Imoto Akira , Asai Akira , Komeda Koji , Fukunishi Shinya , Hirokawa Fumitoshi , Goto Masahiro , Tanaka Keitaro , Okuda Junji , Higuchi Kazuhide , Uchiyama Kazuhisa
Published: December 2019

Introduction:

Reduced port surgery (RPS) has been garnering interest as a novel minimally invasive surgery lately.

Aim:

The authors examined the relationship between the number of ports and surgical outcomes after laparoscopic hepatectomy (LH).

Materials and Methods:

Between January 2012 and April 2019, 209 patients who underwent laparoscopic partial resection and lateral sectionectomy were retrospectively analyzed with respect to operative variables and surgical outcomes. Patients were divided into 5 groups by the number of ports used. Student’s t test, the χ2 test, the likelihood-ratio test, Fisher exact test, or Mann-Whitney U test were used to analyze the data.

Results:

Operative duration was significantly longer in patients with a larger number of ports than in those with a smaller number of ports. Chronological pain scores according to the visual analog scale (VAS) on postoperative days 1, 2, 4, and 7 were not associated with the number of ports and wound length in the umbilical region. The frequency of using additional analgesic agents was not significantly different between the groups. VAS scores and the number of additional analgesic agents used were smaller in patients in whom non–steroidal anti-inflammatory drugs were regularly administered postoperatively than in those in whom the drug was not regularly administered postoperatively. LH had a 3.4% complication rate (Clavien-Dindo classification >IIIA); however, this was not significantly different between the groups.

Conclusions:

No significant difference in postoperative pain was observed between RPS and conventional methods, although operative durations were shorter with RPS. However, RPS for LH may be associated with excellent cosmetic results compared with conventional methods.
Driving biology: The effect of standardized wound management on wound biomarker profiles
Authors: Dente Christopher John , Styrmisdottir Edda , Shi Audrey , Schobel Seth , Khatri Vivek , Potter Benjamin K. , Forsberg Jonathan A. , Buchman Timothy , Kirk Allan D. , Elster Eric
Published: December 2019

BACKGROUND

The timing of coverage of an open wound is based on heavily on clinical gestalt. DoD's Surgical Critical Care Initiative created a clinical decision support tool that predicts wound closure success using clinical and biomarker data. The military uses a regimented protocol consisting of serial washouts and debridements. While decisions around wound closure in civilian centers are subject to the same clinical parameters, preclosure wound management is, generally, much more variable. We hypothesized that the variability in management would affect local biomarker expression within these patients.

METHODS

We compared data from 116 wounds in 73 military patients (MP) to similar data from 88 wounds in 78 civilian patients (CP). We used Wilcoxon rank-sum tests to assess concentrations of 32 individual biomarkers taken from wound effluent. Along with differences in the debridement frequency, we focused on these local biomarkers in MP and CP at both the first washout and the washout performed just prior to attempted closure.

RESULTS

On average, CP waited longer from the time of injury to closure (21.9 days, vs. 11.6 days, p < 0.0001) but had a similar number of washouts (3.86 vs. 3.44, p = 0.52). When comparing the wound effluent between the two populations, they had marked biochemical differences both when comparing the results at the first washout and at the time of closure. However, in a subset of civilian patients whose average number of days between washouts was never more than 72 hours, these differences ceased to be significant for most variables.

CONCLUSION

There were significant differences in the baseline biochemical makeup of wounds in the CP and MP. These differences could be eliminated if both were treated under similar wound care paradigms. Variations in therapy affect not only outcomes but also the actual biochemical makeup of wounds.

LEVEL OF EVIDENCE

Therapeutic, level IV.
A systematic review and meta-analysis evaluating geriatric consultation on older trauma patients
Authors: Eagles Debra , Godwin Bradley , Cheng Wei , Moors Joy , Figueira Sonshire , Khoury Lara , Fournier Karine , Lampron Jacinthe
Published: December 2019

BACKGROUND

Early involvement of geriatrics is recommended for older trauma patients.

OBJECTIVE

This systematic review aimed to determine the impact of a geriatric assessment on mortality, hospital length of stay, discharge destination, and delirium incidence in patients 65 years and older admitted to a trauma center.

METHODS

The protocol was developed according to Preferred Reporting Items for Systematic Review and Meta-analysis guidelines and registered in PROSPERO (CRD42019131870). Search of five databases was completed April 2019. Two independent reviewers completed screening, full text review, and data abstraction. Meta-analysis was performed on outcomes with at least two studies.

RESULTS

A total of 928 unique citations were identified; eight were included in the final analysis. All were cohort studies, most of moderate to poor quality using the Newcastle-Ottawa Scale. We found hospital length of stay decreased by mean of 1.11 days (95% confidence interval, 0.79–1.43), but mortality was unchanged (odds ratio, 1.01; 95% confidence interval, 0.74–1.38) in older patients admitted to a trauma center who had a geriatric consultation. Meta-analysis of discharge destination and delirium incidence was not performed due to heterogeneity.

CONCLUSIONS

This is the first systematic review and meta-analysis to evaluate outcomes in older patients admitted to a trauma center after implementation of a geriatric trauma consultation service. We found a decrease in hospital length of stay but insufficient evidence of change in in-hospital mortality in older patients who received a geriatric consultation as part of their trauma care compared with those that received standard trauma care only. There is a need for more methodologically rigorous research in geriatric trauma.

LEVEL OF EVIDENCE

Systematic review and meta-analysis, level III.
Technical Considerations and Confounders for Urine CXCL10 Chemokine Measurement
Authors: Handschin Joelle , Hirt-Minkowski Patricia , Hönger Gideon , Mitrovic Sandra , Savic Prince Spasenija , Ho Julie , Nickerson Peter , Schaub Stefan
Published: December 2019

Background.

The urine C-X-C motif chemokine 10 (CXCL10) is a promising screening biomarker for renal allograft rejection. The aim of the study was to investigate important technical and biological aspects as well as potential confounders when measuring urine CXCL10.

Methods.

We analyzed 595 urine samples from 117 patients, who participated in a randomized controlled trial investigating the clinical utility of urine CXCL10 monitoring for posttransplant management. Urine CXCL10 was measured by an immunoassay using electrochemiluminescence.

Results.

Intraassay coefficient of variation was 2.5%, and interassay coefficient of variation was 10%. Urine CXCL10 remained stable (ie, <10% degradation) for 8 hours at 25°C or 37°C and for 3 days at 4°C. CXCL10 concentrations [pg/mL] strongly correlated with urine CXCL10/creatinine ratios [ng/mmol] (r2 = 0.98; P < 0.0001). Leucocyturia and active BK-polyomavirus infection are associated with higher CXCL10 concentrations, while allograft function, serum CRP, patient age, proteinuria, urine pH, hematuria, squamous epithelia cell count, and bacteriuria did not correlate with urine CXCL10 concentrations. In 145 paired samples obtained within 1–2 weeks, 80% showed a CXCL10/creatinine ratio change of < ±2 ng/mmol or ±50%, respectively.

Conclusions.

Urine CXCL10 measurement on the used platform is accurate and robust. Leucocyturia and active BK-polyomavirus infection are major confounders, which can be easily detected but represent important diagnostic “blind spots” when using urine CXCL10 to screen for allograft rejection. The intraindividual biological variability of urine CXCL10 within 1–2 weeks is mostly below ±50%, which is still much higher than the technical variability due to sample handling/processing (<20%).
Octreotide Delaying the Progression of Recurrent IgA Nephropathy After Kidney Transplantation
Authors: Sharma Akhil , Hariharan Sundaram
Published: December 2019

IgA Nephropathy (IgAN) is a common cause of end-stage kidney disease worldwide. Unfortunately, the exact pathogenesis of IgAN remains uncertain without any targeted therapy. While kidney transplantation remains the gold standard treatment for those with end-stage kidney disease from IgAN, recurrence occurs frequently and may lead to early kidney transplant loss. Research has suggested that insulin-like growth factor-1 may play a role in mesangial cell proliferation in IgAN and Somatostatin may inhibit insulin-like growth factor-1. In this single case study, we report the use of octreotide, a somatostatin analogue, as a potential novel therapy for early recurrent IgAN post kidney transplant.
De Novo Belatacept in a Kidney-After-Heart Transplant Recipient
Authors: Schenk Austin D. , Anderson Douglas J. , Cole Robert T. , Badell Idelberto R. , Larsen Christopher P.
Published: December 2019

Renal injury almost always accompanies the multisystem organ failure that precedes cardiac transplantation and renal function is further compromised by the nephrotoxicity of calcineurin inhibitors posttransplant. Renal dysfunction in turn causes significant morbidity and mortality. The development of belatacept was motivated by need for an alternative to calcineurin-based immunosuppression, particularly in renal transplantation where the nephrotoxicity of calcineurin inhibitors reduce graft longevity and adverse cardiovascular effects of calcineurin inhibitors increase overall mortality. In 2011, the FDA approved belatacept for use in renal transplantation. Seven-year data from the multicenter randomized phase III BENEFIT trial, which compared belatacept with cyclosporine in renal transplant recipients, show belatacept therapy offers both improved renal function and 43% risk reduction for the combined endpoint of graft loss and death. At present, belatacept use is predominantly confined to renal transplant recipients; however, reports of belatacept use in other transplant settings are emerging. Here, we describe successful long-term use of belatacept in a kidney-after-heart transplant recipient and review use of belatacept in cardiothoracic and other nonrenal transplant settings.
Lysobacter alkalisoli sp. nov., a chitin-degrading strain isolated from saline-alkaline soil
Authors: Xu Lian , Huang Xiao-Xian , Fan De-Liang , Sun Ji-Quan
Published: December 2019

Strains of

Lysobacter

, thought to play vital roles in the environment for their high enzyme production capacity, are ubiquitous in various ecosystems. During an analysis of bacterial diversity in saline soil, a Gram-stain-negative, aerobic, chitin-degrading bacterial strain, designated SJ-36T, was isolated from saline-alkaline soil sampled at Tumd Right Banner, Inner Mongolia, PR China. Strain SJ-36T grew at 4–40 °C (optimum, 30 °C), pH 5.0–10.0 (optimum, pH 7.0–8.0) and 0–6 % NaCl (optimum, 1.0 %). Oxidase and catalase activities were positive. A phylogenetic tree based on 16S rRNA gene sequences and the phylogenomic tree both showed that strain SJ-36T formed a tight clade with

Lysobacter maris

KMU-14T (sharing 97.6 % 16S rRNA gene similarity) and

Lysobacter aestuarii

S2-CT (97.8 %). The major polar lipids of strain SJ-36T were phosphatidylethanolamine, diphosphatidylglycerol, phosphatidylglycerol, two unidentified lipids and one unidentified phospholipid. The major fatty acids were iso-C15 : 0 (37.5 %), summed feature 9 (14.0 %; iso-C17 : 1ω9c and/or C16 : 0 10-methyl) and iso-C11 : 0 (10.6 %). Q-8 was the predominant ubiquinone. Its genomic DNA G+C content was 66.6 mol%. The average nucleotide identity values of strain SJ-36T to

L. maris

KMU-14T,

L. aestuarii

S2-CT and other type strains were 81.5, 79.1 and <79.0 %, respectively. The results of physiological, phenotypic and phylogenetic characterizations allowed the discrimination of strain SJ-36T from its phylogenetic relatives. Lysobacter alkalisoli sp. nov. is therefore proposed with strain SJ-36T (=CGMCC 1.16756T=KCTC 43039T) as the type strain.