bluuebunny/crossref_metadata_2025 huggingface dataset:
Surgery for ulcerative colitis in geriatric patients is safe with similar risk to younger patients
Authors: Feuerstein Joseph D. , Curran Thomas , Alvares Daniel , Alosilla Michael , Lerner Andrew , Cataldo Thomas , Falchuk Kenneth R. , Poylin Vitaliy
Published: September 2019

Objective

A prior study indicated that postoperative mortality and complications were higher in geriatrics with inflammatory bowel disease (IBD). We sought to assess the rates of surgical complications and mortality in patients aged ≥65 years after colectomy for ulcerative colitis (UC).

Methods

This is a single center retrospective study at a tertiary care center. We reviewed all hospital discharges with ICD-9 code 556.X between January 2002 and January 2014. Patients were included if they underwent a colectomy for UC. All records were manually reviewed for demographics, complications and mortality within 90 days postoperatively.

Results

A total of 259 patients underwent surgery for UC during the study period and 34 patients were ≥65 years old (range 65–82) at the time of their surgery. There was no difference in overall length of stay (10.5 days vs. 9.6 days; P = 0.645) or complication rates (44% vs. 47%; P = 0.854) in the ≥65 cohort compared with the under 65 cohort. Mortality was higher in the geriatric cohort but this included only two deaths within 90 days, one of which was unrelated to the surgery, compared with one death related to surgery within 90 days in the younger cohort. Readmissions occurred in 24% of both cohorts within 90 days.

Conclusion

Geriatric patients undergoing surgery for UC are not at increased risk of surgery-related morbidity or mortality compared with a younger cohort.
Graft-versus-host disease after living donor liver transplantation: an unpredictable troublesome complication for liver transplant centers
Authors: Gonultas Fatih , Akbulut Sami , Barut Bora , Kutluturk Koray , Yilmaz Sezai
Published: September 2019

Objective

The aim of this study was to report on graft-versus-host disease (GvHD) following living donor liver transplantation (LDLT).

Methods

Between May 2002 and January 2019, a total of 2387 LT procedures were performed in our Liver Transplantation Institute. Seven patients (0.29%) were admitted to our outpatient clinic with signs and symptoms compatible with GvHD following LT. Demographic, clinical and histopathological characteristics of patients with GvHD were retrospectively evaluated.

Results

There were six male and one female patient aged from 18 months to 67 years. Acute GvHD was detected in six patients and chronic GvHD in one. Grade II GvHD was detected in six patients, and Grade IV was detected in one patient. Time from LT to GVHD ranged from 4 to 657 days (median: 59 days). Time from beginning of clinical findings to histopathological diagnosis ranged from 2 to 160 days (median: 7 days). Initial clinical manifestations were as follows: skin rash + diarrhea (n = 2), skin rash (n = 2), skin rash + flushing (n = 1), diarrhea (n = 1), and skin rash + fever (n = 1). Despite intensive treatments, five out of seven patients (71.4%) died due to sepsis (n = 4) and gastrointestinal hemorrhage (n = 1). The remaining two patients are still alive without complications.

Conclusion

GvHD is a life-threatening complication despite aggressive treatment. To achieve success in GvHD, preventive measures, early diagnosis, early initiation of treatment, antimicrobial prophylaxis, and proper supportive care should be ensured.
Predictive factors for secondary intensive care unit admission within 48 hours after hospitalization in a medical ward from the emergency room
Authors: Cancella de Abreu Marta , Rousseau Alexandra , Ehrminger Sebastien , Rufat Pierre , Hausfater Pierre
Published: September 2019

Background

Unplanned transfer to an ICU within 48 hours of admission from the emergency department (ED) can be considered an adverse event. Screening at risk for such an event is a challenge for ED staff. Our purpose was to identify the clinical and biological variables which may be identified in the ED setting and can predict short-term unplanned secondary transfer to the intensive care setting.

Methods

This was a three-year retrospective case controlled monocentric study. The cases were patients transferred to a medical ICU within 48 hours of admission to the general wards from the ED. Each case was matched to two controls (patients not transferred to the ICU) based on age, gender, year of admission, and hospital unit. A conditional logistic regression was performed.

Results

Three hundred nineteen patients, including 107 cases and 212 controls, were studied. Community-acquired pneumonia (CAP) was the most frequent diagnosis (23% of cases) followed by sepsis (16%). We identified six predictive factors of an unplanned short-term transfer to the ICU. Former smoking status, fever between 38°C and 40°C, dyspnea as the chief complaint in the ED, a lower MEDS score, an elevated acute physiology age chronic health evaluation score, and the ordering of an arterial blood gas each correlate with secondary transfer to an intensive care setting.

Conclusion

We report a higher risk of short-term unscheduled ICU transfer in patients meeting these criteria. These patients should be closely monitored and frequently re-evaluated before being transferred to a general ward.
Prevention and Management of Supine Hypertension in Patients With Orthostatic Hypotension
Authors: Moroi Morgan K. , Ruzieh Mohammed , Ahmed Aamir , Kanjwal Shaffi , Kanjwal Khalil
Published: September 2019

Background:

Orthostatic hypotension (OH) is a potentially debilitating condition caused by dysfunction of the autonomic nervous system, which is essential for the physiologic response to orthostatic posture. In addition to OH, autonomic dysfunction may also be associated with the development of concurrent supine hypertension (SH).

Areas of Uncertainty:

This paradoxical effect speaks to the complexity of the pathogenesis of autonomic disease and greatly complicates management of these patients. Clinicians are faced with a dilemma because aggressive treatment of orthostatic intolerance can worsen supine hypertension and attempts to control supine hypertension can worsen orthostatic intolerance.

Data Sources:

Systematic review of the published literature.

Prevention of Supine Hypertension:

Patients should aim to avoid known stressors, perform physical maneuvers (eg, slowly getting up from bed, sleeping with head of bed elevated), manage underlying related conditions (eg, diabetes mellitus), and exercise.

Management of Supine Hypertension:

With failure of conservative management, patients may advance to pharmacologic therapy. It is important to understand the underlying suspected etiology of the syndrome of supine hypertension and OH (SH-OH) to select promising pharmacologic agents. This article reviews medical treatment options to work toward achieving a better quality of life for patients afflicted with this disease. Although clonidine and beta-blockers can be used to treat hypertension without causing significant hypotension, midodrine, pyridostigmine, and droxidopa may be helpful in preventing OH.

Conclusion:

The etiology and severity of autonomic dysfunction vary widely between patients, suggesting a need for an individualized treatment approach. Achieving perfect blood pressure control is not a realistic goal. Rather, treatment should be aimed at improving the patient's quality of life and decreasing their risk of injury and organ damage.
Effect of arm cycling and task-oriented exercises on fatigue and upper limb performance in multiple sclerosis: a randomized crossover study
Authors: Gervasoni Elisa , Cattaneo Davide , Bertoni Rita , Grosso Cristina , Bisio Ambra , Rovaris Marco , Bove Marco
Published: September 2019

Rehabilitation treatments have been proven to be a viable way to reduce fatigue and upper limb impairments in people with multiple sclerosis (PwMS). Our aim was to examine which treatment has better short-term and carryover effects on fatigue and manual dexterity in multiple sclerosis population. Twenty PwMS participated in a 16-week randomized crossover study composed of 20 sessions. The participants were divided into two groups (group A and group B). Sessions containing combined arm cycling and task-oriented exercises were administered by a physical therapist in hospital setting. Each group received 20 sessions of aerobic training and task-oriented exercises and then an 8-week rest period or vice versa with group A receiving sessions first. Fatigue was assessed by using the Modified Fatigue Impact Scale (MFIS) and Motor Fatigability Index (MFI), which was assessed using an engineered glove during a fatiguing finger tapping task. To measure manual dexterity, the nine hole peg test (NHPT) and a rate of tapping at maximum velocity task (RATE-MV) were utilized. Treatment effects were assessed by t-test or Mann–Whitney test at the end of both periods checking for carryover effects. After treatment the combined (Groups A and B) between-period differences were MFIS: 5.2 (10.7) points, P = 0.05; MFI: −0.007 (<0.001)Hz/s, P = 0.05 and RATE-MV: 0.2 (0.4) Hz/s, P = 0.05 in favor of the treatment period. No statistically significant between-period differences were found for the NHPT: 3.6 (25.0) s, P = 0.63. No carryover effects (P > 0.05) were observed. In conclusion, sessions of arm cycling and tailored task-oriented exercises have shown to be a viable resource for treating manual dexterity and fatigue in PwMS.
Malaria in Pregnancy: What the Obstetric Provider in Nonendemic Areas Needs to Know
Authors: Zakama Arthurine K. , Gaw Stephanie L.
Published: September 2019

Importance

Globally, more than 125 million women each year are at risk of malaria during pregnancy. Endemic regions carry the greatest burden; however, with globalization, providers in nonendemic regions are encountering increasing numbers of women exposed to or infected with malaria.

Objectives

The aim of this article is to provide obstetric providers in nonendemic areas with updated information on malaria infection in pregnancy focusing on pregnancy management and malaria prevention and treatment.

Evidence Acquisition

This article is based on review of the most recent peer-reviewed articles and guidelines from the Centers for Disease Control and Prevention and the World Health Organization.

Findings

Malaria infection in pregnancy causes maternal anemia, low birth weight, preterm birth, stillbirth, and miscarriages through placental malaria and severe infections. Pregnant women traveling to malaria-endemic areas should be advised against travel. If travel must occur, they should be provided with region-specific chemoprophylaxis and given methods for preventing infection. In the event that a pregnant patient has an acute malarial infection, prompt evaluation is needed to determine whether there are severe features. Medications for uncomplicated or severe malaria infection should be started as soon as the diagnosis is made.

Conclusions and Relevance

Malaria in pregnancy causes significant perinatal complications. Obstetric providers should be aware of the impact and how to prevent and treat malaria infection during pregnancy. Malaria infection should be suspected in women with concerning symptoms and recent travel to endemic areas. Providers should know the management of uncomplicated and severe malarial infection in pregnancy.

Target Audience

Obstetricians and gynecologists, family physicians.

Learning Objectives

After completing this activity, the learner should be better able to assess the adverse pregnancy outcomes associated with malarial infection; evaluate and manage patients traveling to endemic areas during pregnancy; and formulate a treatment plan for acute malaria infection.
The Efficacy and Safety of Tipapkinogen Sovacivec Therapeutic HPV Vaccine in Cervical Intraepithelial Neoplasia Grades 2 and 3: Randomized Controlled Phase II Trial with 2.5 Years of Follow-up
Authors: Harper Diane M. , Nieminen Pekka , Donders Gilbert , Einstein Mark H. , Garcia Francisco , Huh Warner K. , Stoler Mark H. , Glavini Katerina , Attley Gemma , Limacher Jean-Marc , Bastien Berangere , Calleja Elizabeth
Published: September 2019

(Abstracted from Gynecol Oncol 153 (2019) 521–529)

On a global scale, cervical cancer comprises approximately 80% of human papillomavirus (HPV)–associated cancers. These cancers are most often treated surgically, and despite a high surgical success and vaccine prevention rate; there exists a need for nonsurgical, nonablative techniques to treat HPV-associated cancers.
Association Between Interpregnancy Interval and Adverse Birth Outcomes in Women With a Previous Stillbirth: An International Cohort Study
Authors: Regan Annette K. , Gissler Mika , Magnus Maria C. , Haberg Siri E. , Ball Stephen , Malacova Eva , Nassar Natasha , Leonard Helen , Pereira Gavin
Published: September 2019

(Abstracted from Lancet 2019;393:1527–1535)

Interpregnancy interval (IPI; the length of time between pregnancies) is a risk factor for adverse outcomes in infants and their mothers. The World Health Organization recommends women wait at least 2 years after a live birth and 6 months after miscarriage or abortion before conceiving again, but there is no recommendation for the best IPI after stillbirth.
Thymic Mucoepidermoid Carcinoma: A Systematic Review and Meta-analysis
Authors: Hamza Ameer , Younes Ahmed I. , Kalhor Neda
Published: September 2019

Thymic mucoepidermoid carcinoma is a rare tumor that remains poorly characterized and a diagnostic challenge. The aim of this review is to characterize this tumor in a larger cohort of patients using all the available cases in the literature. We systematically searched the PubMed and Scopus database for primary thymic mucoepidermoid carcinoma. A total of 24 studies were included in the final analysis. A total of 41 patients were identified; 23 (56.1%) were male and 18 (43.9%) were female. Mean age was 49.8±21.3 years. Mean tumor size was 7.6±3.5 cm. Twenty (66.7%) were low grade and 8 (26.7%) were high grade. In total, 20 (55.6%) patients were treated with surgery alone. Nodal dissection was performed in 4 cases only. Two patients had MAML2 gene rearrangement and 2 were negative. Follow-up time varied from 2 to 93 months. A total of 13 (44.8%) patients died of disease with a median survival of 12 months. There seems to be a bimodal age distribution with peaks between second and third decades of life, and between sixth and eight decades. Lymph node sampling is frequently not performed; however, we recommend performing it, as it may lead to more accurate staging. There is limited data regarding the utility of MAML2 gene rearrangement in the thymic location. Histologic grade and tumor stage/resectability are the main prognostic factors.
A Clinicopathologic and Molecular Analysis of Fumarate Hydratase-deficient Renal Cell Carcinoma in 32 Patients
Authors: Lau Hubert D. , Chan Emily , Fan Alice C. , Kunder Christian A. , Williamson Sean R. , Zhou Ming , Idrees Muhammad T. , Maclean Fiona M. , Gill Anthony J. , Kao Chia-Sui
Published: September 2019

Fumarate hydratase-deficient renal cell carcinoma (FH-deficient RCC) is a rare and recently described entity associated with hereditary leiomyomatosis and RCC syndrome. FH-deficient RCC may show variable clinical and pathologic findings, but commonly presents with locally advanced and metastatic disease and carries a poor prognosis. We identified 32 patients with FH-deficient RCC, confirmed by FH immunohistochemistry (IHC) and/or FH mutation analysis, and performed a retrospective review of the clinical and pathologic features. Median age at presentation was 43 years (range, 18 to 69 y), and the M:F ratio was 2.2:1. Median tumor size was 6.5 cm (range, 2.5 to 28 cm), and 71% presented at stage ≥pT3a. After a median follow-up of 16 months (range, 1 to 118 mo) in 26 patients, 19% showed no evidence of disease, 31% were alive with disease, and 50% were dead of disease. The vast majority of cases showed multiple histologic growth patterns, with papillary (52%) being the most common predominant pattern, followed by solid (21%), cribriform/sieve-like (14%), sarcomatoid (3%), tubular (3%), cystic (3%), and low-grade oncocytic (3%). Viral inclusion-like macronucleoli with perinucleolar clearing were present in almost all cases (96%). All cases were evaluated using FH IHC, and 3 cases (9%) showed retained FH expression. Nineteen cases had germline or tumor mutation analysis confirming a FH mutation, with 79% (11/14) of cases showing mutations within coding regions and 21% (3/14) showing mutations within intronic splice-sites. By IHC, 97% (32/33) of cases were negative for CK7, 93% (27/29) were negative for p63, and 52% (15/29) were negative for GATA3. All cases stained were positive for PAX8 and showed retained succinate dehydrogenase B expression. Our overall findings show that FH-deficient RCC is considerably heterogenous in morphology and frequently behaves aggressively. Suspicion for this entity should be raised even in the absence of predominantly papillary architecture and characteristic nucleolar features. We have included cases with uncommonly seen features, including 4 cases with predominantly cribriform/sieve-like architecture as well as one case with pure low-grade oncocytic morphology (9 y of clinical follow-up without evidence of disease). Although FH IHC is a useful tool for identifying cases of FH-deficient RCC, not all cases of FH-deficient RCC show loss of FH staining, and FH mutation analysis should be considered for patients with suspicious clinical or pathologic features, even in cases with retained FH IHC expression.
Developing Pediatric Critical Care in Kenya*
Authors: Kumar Rashmi , Canarie Michael F.
Published: September 2019

Objective:

To describe efforts to improve the care of critically ill children in a tertiary care public hospital in a resource-limited setting.

Design:

Descriptive.

Setting:

Pediatric wards at the Kenyatta National Hospital in Nairobi, Kenya.

Patients:

Critically ill children admitted to the hospital.

Interventions:

A graduated approach to improving critical care capacity in a resource-limited setting.

Measurements and Main Results:

Pediatric mortality was tracked in the adult ICU and PICU following the engagement of a pediatric intensivist and creation of a critical care team. Mortality declined from 76.2% to 37.5% in the first 2 years of the new PICU.

Conclusions:

Caring for critically ill children in resource-limited setting presents many challenges. The stepwise approach described here has led to a nearly 50% reduction in mortality among critically ill children at Kenyatta National Hospital. It is a viable strategy to begin to address the disproportionate number of critically ill and injured children in resource-limited setting.
Impact of Ondansetron Prescription on Return Emergency Department Visits Among Children with Acute Gastroenteritis
Authors: McLaren Son H. , Yim Ramy B. , Fleegler Eric W.
Published: September 2019

Objectives

The objective of this study was to determine if providing ondansetron prescription to children with acute gastroenteritis seen in the emergency department (ED) is associated with reduced unscheduled ED revisits.

Methods

This was a retrospective comparative cohort study conducted in a tertiary urban pediatric ED. We evaluated otherwise healthy children 6 months to 18 years old who presented to the ED between 2010 and 2015 and were discharged home with acute gastroenteritis diagnosis. Illness severity was determined using dehydration score, emergency severity index, and presenting symptoms. The incidence of unscheduled 72-hour ED revisit among patients discharged home with ondansetron prescription was compared with those without a prescription.

Results

Of the 11,785 eligible patients, 35.5% (N = 4,187) of patients were discharged home with ondansetron prescription. After adjustment for emergency severity index, age, insurance source, race, time of index visit registration, intravenous fluid use, and ED–administered ondansetron, there were no differences in the rates of ED revisit (adjusted odds ratio [aOR] = 1.12 [0.92, 1.33]) or admission after ED revisit (aOR = 0.81 [0.51, 1.27]) among children with versus without ondansetron prescription. No difference was found in the proportion of alternative diagnoses among returning patients with versus without ondansetron prescription (aOR = 0.56 [0.20, 1.59]).

Conclusions

There was no association between ondansetron prescription and ED revisit among children seen in the ED with suspected acute gastroenteritis. In the appropriate setting, however, physicians may consider prescribing ondansetron for symptom control in conjunction with careful discharge instructions.
Expression of Cathepsins B, D, and G by the Embryonic Stem Cell–Like Population within Human Keloid Tissues and Keloid-Derived Primary Cell Lines
Authors: Paterson Claudia , Lee Valerie M. Y. , Brasch Helen D. , van Schaijik Bede , Marsh Reginald , Tan Swee T. , Itinteang Tinte
Published: September 2019

Background:

The authors have previously shown that an embryonic stem cell–like population within keloid-associated lymphoid tissues in keloid lesions expresses components of the renin-angiotensin system that may be dysregulated. The authors hypothesized that cathepsins B, D, and G are present within the embryonic stem cell–like population in keloid lesions and contribute to bypass loops of the renin-angiotensin system.

Methods:

3,3′-Diaminobenzidine immunohistochemical staining for cathepsins B, D, and G was performed on formalin-fixed paraffin-embedded sections in keloid tissue samples of 11 patients. Immunofluorescence immunohistochemical staining was performed on three of these keloid tissue samples, by co-staining with CD34, tryptase, and OCT4. Western blotting, reverse transcription quantitative polymerase chain reaction, and enzyme activity assays were performed on five keloid tissue samples and four keloid-derived primary cell lines to investigate protein and mRNA expression, and functional activity, respectively.

Results:

3,3′-Diaminobenzidine immunohistochemical staining demonstrated expression of cathepsins B, D, and G in all 15 keloid tissue samples. Immunofluorescence immunohistochemical staining showed localization of cathepsins B and D to the endothelium of microvessels within the keloid-associated lymphoid tissues and localization of cathepsin G to the tryptase-positive perivascular cells. Western blotting confirmed semiquantitative levels of cathepsins B and D in keloid tissue samples and keloid-derived primary cell lines. Reverse transcription quantitative polymerase chain reaction showed quantitative transcriptional activation of cathepsins B and D in keloid tissue samples and keloid-derived primary cell lines and cathepsin G in keloid tissue samples. Enzyme activity assays demonstrated functional activity of cathepsins B and D.

Conclusion:

Cathepsins B, D, and G are expressed by the embryonic stem cell–like population within the keloid-associated lymphoid tissues of keloid lesions and may act to bypass the renin-angiotensin system, suggesting a potential therapeutic target using renin-angiotensin system modulators and cathepsin inhibitors.
Neurotized Platysma Graft: A New Technique for Functional Reanimation of the Eye Sphincter in Longstanding Facial Paralysis
Authors: Nassif Tomaz , Yung Chia Chang
Published: September 2019

Background:

In 1984, Terzis reported on the potential use of a free platysma muscle transfer to reanimate the orbicularis oculi in longstanding paralysis of this unit. However, the vascularized platysma flap proved difficult to transfer, and this technique is not widely used today. In the present study, the authors have described the technique involving grafting of the platysma muscle to restore eyelid function and retrospectively discussed its clinical outcomes.

Methods:

This retrospective analysis included patients with longstanding facial paralysis who underwent orbicularis oculi reconstruction with neurotized platysma grafts. The authors have described the surgical technique and its retrospective clinical outcomes.

Results:

Between 1992 and 2015, 38 consecutive patients underwent this procedure; of them, 34 [16 men (47 percent) and 18 women (53 percent)] completed the follow-up. The time between the first and second surgical stages was a mean 8.6 months (range, 6 to 22 months). The surgical results were good in 18 patients (53 percent) and the recovery was satisfactory in 13 (38 percent).

Conclusions:

This study confirmed the feasibility and effectiveness of grafted muscle functional recovery and the efficiency of neuromuscular neurotization. The presented surgical technique is safe and effective for treating longstanding facial palsy of the orbicularis oculi muscle. This is the only technique that is easy and reproducible, leads to facial nerve recovery, and places a similar muscle at the original site of the paralyzed muscle for functional recovery.

CLINICAL QUESTION/LEVEL OF EVIDENCE:

Therapeutic, IV.
Spectrum of 18F-FDG Uptake in Bilateral Lung Parenchymal Diseases on PET/CT
Authors: Prabhu Meghana , Raju Shobhana , Chakraborty Dhritiman , Arora Saurabh , Kumar Rakesh
Published: September 2019

Bilateral lung parenchymal involvement is seen in infective as well as noninfective conditions, appearing as focal or diffuse lung disease. PET/CT with FDG helps in characterization (increased glucose utilization is seen by both inflammatory and neoplastic cells). In this article, we describe the spectrum of patterns of FDG uptake and associated CT changes involving bilateral lung parenchyma. Benign conditions described are aspiration pneumonia; pulmonary toxicity by bleomycin; infections, namely, sarcoidosis, miliary pulmonary tuberculosis, and pulmonary nocardiosis; and inflammatory conditions such as pulmonary Langerhans cell histiocytosis and pulmonary alveolar proteinosis. Neoplastic conditions described are bilateral pulmonary metastases and lymphangitic carcinomatosis.
Atypical Parkinson Syndrome Hiding a Meningioma
Authors: Bund Caroline , Ouvrard Eric , Renaud Mathilde , Tranchant Christine , Namer Izzie-Jacques
Published: September 2019

A 59-year-old man had developed within a few months walking disorders and rigidity of the left upper limb. 123I-FP-CIT SPECT/CT was performed in response to the suspicion of atypical parkinsonian syndrome. It showed an anomaly in presynaptic dopaminergic transmission on the right striatum and a voluminous expansive process on CT. MRI revealed an atypical meningioma. The patient had surgery for tumor removal. Later 123I-FP-CIT SPECT/CT showed normalization of presynaptic dopaminergic transmission on the right striatum.
Early-Phase 18F-Florbetaben PET as an Alternative Modality for 18F-FDG PET
Authors: Son Seung Hyun , Kang Kyunghun , Ko Pan-Woo , Lee Ho-Won , Lee Sang-Woo , Ahn Byeong-Cheol , Lee Jaetae , Yoon Uicheul , Jeong Shin Young
Published: September 2019

Purpose

Based on the possibility that early-phase florbetaben (E-FBB) brain PET can be a surrogate for brain perfusion imaging, we conducted this study to investigate the clinical utility of E-FBB PET instead of 18F-FDG brain PET.

Materials and Methods

This prospective study included 35 patients with clinical suspicion of cognitive decline or dementia and 5 healthy controls. Brain MRI, E-FBB PET, late-phase FBB PET, and FDG PET were acquired. The regional SUV ratios (SUVRs) were calculated by cortical surface region of interest analysis using individual MRI, and relationship between E-FBB and FDG PET was analyzed. All PET scans were scored and analyzed as per visual scoring system, which represent tracer uptake abnormality. Moreover, uptake patterns were analyzed to determine the disease.

Results

Among the 40 subjects, 19 were amyloid-positive and 21 were amyloid-negative on late-phase FBB PET. Cortical surface region of interest analysis conducted for comparing between E-FBB and FDG PET revealed significant correlations (P < 0.0001) for regional SUVR among all brain regions; however, the SUVR values of FDG PET were statistically higher than those of E-FBB PET. Similarly, although the visually rated scores for E-FBB and FDG PET showed significant correlation (P < 0.0001), it was considered that the tracer uptake was more severely decreased for FDG PET. The disease types, specified by E-FBB and FDG PET, were statistically correlated.

Conclusions

E-FBB PET could potentially be a useful biomarker for the diagnosis of dementia in place of FDG PET. Nevertheless, the severity of the disease was more accurately determined by FDG PET.
Increased FDG Uptake in the Center of the Gallbladder Stone
Authors: Ji Xia , Dong Aisheng
Published: September 2019

We present a case with a large gallbladder stone showing central hypermetabolism detected incidentally by an FDG PET/CT scan. However, the same gallbladder stone did not showed any FDG activity on the FDG PET/CT scan performed 2 years ago. The mechanism of variable FDG uptake in the same gallbladder stone is unclear, which needs further investigation.
Scrotal Fibroepithelial Polyp With Acute and Chronic Inflammation Mimics Malignancy on 18F-FDG PET/CT Imaging
Authors: Chuang Tzyy-Ling , Tseng Chih-En , Huang Shih-Wen , Wang Yuh-Feng
Published: September 2019

Computed tomography (CT) of a 68-year-old man showed multiple small nodules in the bilateral lungs (maximum 14 mm in the left upper lobe). CT-guided biopsy of left upper lobe lesion showed no tumor or granuloma. Fluorodeoxyglucose (FDG) PET/CT showed multiple nodules with background-to-mild FDG-avid activity, and an incidental left scrotal skin lesion with intensely increased accumulation of 18F-FDG (SUVmax, 11.7), suspected malignant. After urologist consultation, local dermatological findings suggested a huge wart. Excision was done, and pathology concluded nodular papillary fibroepithelial polyp with acute and chronic inflammation.
Orbital Adult T-Cell Leukemia/lymphoma With Skin Involvement Demonstrated on FDG PET/CT
Authors: Hotta Masatoshi , Minamimoto Ryogo
Published: September 2019

An 85-year-old woman presented with decreased visual acuity. MRI of the brain revealed bilateral orbital masses, and FDG-PET/CT demonstrated moderate to intense uptake in the orbital tumors and thickened skin on the left lower leg. Biopsies of the orbital and cutaneous lesions revealed infiltration by T-cell lymphoma, and the presence of human T-cell lymphotropic virus type 1 antigens confirmed the diagnosis of adult T-cell leukemia/lymphoma (ATLL). Although orbital ATLL is rare, the skin is a common site of extranodal involvement of T-cell lymphomas, including ATLL, and FDG uptake by a cutaneous lesion can facilitate early diagnosis.
Decrease in 18F-Florbetapir Accumulation in the Cerebral Hemisphere With Hypoperfusion and Misery Perfusion Due to Chronic Atherosclerotic Occlusion of the Internal Carotid Artery
Authors: Takahashi Tatsuhiko , Kobayashi Masakazu , Fujiwara Shunrou , Kubo Yoshitaka , Terasaki Kazunori , Ogasawara Kuniaki
Published: September 2019

A 67-year-old man had a slowly progressing impairment of recent memory. Cerebral angiography showed atherosclerotic occlusion of the right internal carotid artery with insufficient collateral circulation. Positron emission tomography (PET) using 15O2 gas showed reduced cerebral blood flow, reduced cerebral metabolic rate of oxygen, and elevated oxygen extraction fraction in the precentral region of the right cerebral hemisphere. Use of 18F-florbetapir PET depicted amyloid β deposition as decreased tracer uptake in the precentral region in the right cerebral hemisphere when compared with the contralateral hemisphere.
Pituitary Adenoma on 18F-Fluciclovine PET/CT
Authors: Wang Jiaqiong , Foley Mark , Kuker Russ
Published: September 2019

A 69-year-old man presented with lower urinary tract symptoms and prostate biopsy showed prostate cancer. 18F-Fluciclovine PET/CT revealed abnormal increased radiotracer uptake within the prostate gland, and multiple osseous structures, suspicious for tumoral involvement. Incidentally, an expansile soft tissue density mass arising from sella turcica demonstrated increased radiotracer activity. MRI showed a lobulated enhancing mass centered in the sella and eroding into the sphenoid sinus. The differential diagnosis includes pituitary macroadenoma versus prostate cancer metastasis. The tumor was resected and the pathological diagnosis was pituitary adenoma.
Risk Factors Associated With Postoperative Recurrence in Patients With Tenosynovial Giant Cell Tumor of the Hand
Authors: Shi Jialu , Zheng Jingwei , Zhou Xijie , Li Zhijie , Chen Xinglong , Gao Weiyang , Yan Hede
Published: September 2019

Identification of risk factors for recurrence of tenosynovial giant cell tumors of the hand is crucial to provide adequate preoperative counseling and tailor surgical treatment. However, the risk factors are still controversial, which are the subject of this research.

Recently, we conducted a retrospective cohort study of 135 consecutive patients with giant cell tumors of the tendon sheath of the hand from January 2010 to July 2016. All patients underwent surgical excision, received necessary imaging examinations, and had routine follow-up and thus were identified as those who had recurrence by confirmation of reoperation, and the duration ranged from 24 to 103 months (mean, 53.5 ± 21.4 months). There were 14 local recurrences (10.4%) within 6 to 24 months, respectively, after surgery. Data pertaining to sex, age, tumor sites, tumor size, tumor number, course of disease, bone erosion, tumor growth patterns, anesthesia mode, and the surgeon's experience were all extracted, and Cox regression models were used to estimate recurrence rate with adjustment for potential confounders.

According to the Cox regression analysis, the recurrence rate after surgery was significantly higher in patients with a diffused form than in those with a localized one (P = 0.001); in addition, patients with 2 or more tumors had a much higher postoperative recurrence rate than did those with only 1 tumor (P = 0.023).

This study suggested that the recurrence rate of tenosynovial giant cell tumors of the hand was closely related to the tumor number and tumor growth patterns.
Intercostal Nerve Transfer in Management of Biceps and Triceps Cocontraction in Spontaneously Recovered Obstetric Brachial Plexus Palsy
Authors: Semaya Ahmad Elsayed , El-Nakeeb Ramy , Hasan Mohammad , Shams Ahmed
Published: September 2019

Background

Obstetric brachial plexus palsy is caused by traction during birth. Most patients regain useful function with spontaneous recovery. In some cases, cross reinnervation occurs between the biceps and triceps muscles. In these cases, smooth active motion of the elbow joint is impaired by simultaneous biceps and triceps muscle contraction. The biceps and triceps muscle cocontraction could be treated by botulinum toxin type A injection, tendon transfer of the triceps to biceps, and intercostal nerves transfer to the musculocutaneous nerve (MCN) or to the motor branch of the radial nerve to the triceps muscle.

Patients and Methods

We present 16 cases (10 males and 6 females) with biceps and triceps cocontraction in spontaneously recovered obstetric brachial plexus palsy patients. They were treated by 3 intercostal nerves transfer to MCN without exploration of the remaining plexus. The mean age at surgery was 40.6 months (range, 24–65 months). Preoperative electromyography was done in all cases to confirm biceps and triceps cocontraction and to assess the contractile status of both muscles.

Results

The mean postoperative follow-up period was 51.7 months (range, 27–64 months). At the final follow-up, elbow flexion was graded 3 in 1 patient, grade 4 in 3 patients, grade 6 in 9 patients, and grade 7 in 3 patients using the 7-point Toronto scale. The mean active range of motion of the elbow (against gravity) increased from 38 degrees preoperatively (range, 0–75 degrees) to 96.8 °̊ at the final follow-up (range, 60–140 degrees).

Conclusions

Intercostal nerves transfer to MCN for management of biceps, and triceps cocontraction in spontaneously recovered obstetric brachial plexus injury is a good option with minimal morbidity and high success rate.
Qualitative Assessment of Columella Scar Quality After Extended Mohler Unilateral Cleft Lip Repair
Authors: Eisemann Bradley S. , Kantar Rami S. , Ramly Elie P. , Alfonso Allyson R. , Wang Maxime , Flores Roberto L.
Published: September 2019

Background:

The Extended Mohler cleft lip repair restores upper lip form using a columellar flap to fill the defect created by the downward rotation of Cupid's bow. The resulting columella incision is mentioned as a potential drawback. This study seeks to evaluate the morbidity of the resulting scar.

Materials and methods:

This retrospective study enrolled 50 unilateral cleft lip patients treated using the Extended Mohler repair. 5 reviewers examined post-operative images. Three validated scar assessment scales were utilized: Manchester Scar Scale (MSS), Modified Scar-Rating Scale (MSRS), and Stony Brook Scar Evaluation Scale (SBSES). A scar score for the lip and columellar portion of each patient was determined.

Results:

Three different scar scales demonstrated significantly better scar quality for the columellar portion of the scar compared to the lip portion. The average score for the lip and columella using the MSS was 7.0 ± 1.4 and 5.7 ± 1.1 (P <0.001). The average score for the lip and columella using the MSRS was 5.5 ± 1.4 and 4.3 ± 0.9 (P <0.001). The average score for the lip and columella using the SBSES was 3.5 ± 1.1 and 3.9 ± 0.7 (P = 0.014). The intraclass correlation coefficient for lip scar assessments was 0.901 (MSS), 0.91 (MSRS), and 0.873 (Stony Brook Evaluation Scale [SBES]). The intraclass correlation coefficient for columellar scar assessment was 0.786 (MSS), 0.761 (MSRS), and 0.726 (SBES).

Conclusion:

The Extended Mohler unilateral cleft lip columellar scar is of superior quality compared to the lip portion. This analysis ameliorates one of the major concerns regarding the Extended Mohler cleft lip repair.
Long-Term Outcomes for Adult Patients With Cleft Lip and Palate
Authors: Connolly Katharine A. , Kurnik Nicole M. , Truong Tuan A. , Muller Cristiane , Beals Patricia H. , Singh Davinder J. , Beals Stephen P.
Published: September 2019

The purpose of this study was to evaluate a single center's experience with adult patients who had cleft lip, cleft palate, or both. The authors aimed to identify common long-term needs in this patient population and evaluated the relationship of team-based care in meeting those needs. To do so, the authors retrospectively reviewed chart records from a single private practice and tertiary referral cleft center for all patients who were ≥15 years of age and who had a history of clefts of the lip or palate, or both, from January 1, 2013, to June 30, 2014. The authors compared the concerns of the patients who received cleft-team–based care by a single, multidisciplinary cleft team; multiple multidisciplinary cleft teams; or no formal cleft team. The authors analyzed data for 142 patients. The most common patient concerns were lip aesthetics (64%), nose aesthetics (61%), septal deviations (47%), nasal obstruction (44%), malocclusion (32%), oronasal fistulas (29%), and speech (21%). Oronasal fistulas were more commonly reported in the group of patients who had care by multiple teams (42.9%; P < .001). Malocclusion was more commonly reported in the group of patients who had care by multiple teams (50%; P = .001). The authors found that adult patients who have undergone rehabilitation for cleft lip and palate appear to have a common set of long-term needs. Multidisciplinary cleft-team–based care appears to be the most effective way to address these needs.
Coordination of the Fetal Medicine Institute and the Cleft and Craniofacial Center: Application to Early Management of Infants With Cleft Lip and Palate
Authors: Fan Kenneth L. , Black Cara K. , Mantilla-Rivas Esperanza , Bulas Dorothy I. , Rubio Eva , Blask Anna R. , Robinson Chelsea , Oh Albert K.
Published: September 2019

Background/Purpose:

The primary objective of this study is to describe the authors’ experience at the Children's National Health System with the coordination of the Fetal Medicine Institute and the Cleft and Craniofacial Center. This collaboration highlights the accuracy and completeness of prenatal diagnosis of cleft abnormalities with expedient postnatal management.

Methods:

With Institutional Review Board approval, the authors retrospectively reviewed 74 patients referred for potential orofacial cleft and 44 met the inclusion criteria. Follow-up fetal ultrasonography is typically performed and three-dimensional imaging was performed when feasible. If questionable anomalies or facial findings are present on these studies, the authors proceed with fetal magnetic resonance imaging. A thorough consultation is held with the cleft team, resulting in a comprehensive plan of care. Postnatal examination confirmed the correct prenatal diagnosis in nearly all patients.

Results:

Sensitivity and specificity for isolated unilateral cleft lip were 89% and 100%, respectively; for unilateral cleft lip and palate, sensitivity and specificity were 82% and 90%, respectively; for bilateral cleft lip and palate, sensitivity and specificity were 97% and 90%, respectively. Initial postnatal evaluation by the cleft surgeon occurred at an average age of 21 days after birth. All patients who were candidates for presurgical orthodontia were treated at an appropriate young age (mean: 66.5 days).

Conclusions:

Coordinated prenatal evaluation of patients with cleft lip/palate by multidisciplinary centers plays an important role in the care of these complex patients. The results of the authors’ study demonstrated high sensitivity and specificity for the prenatal diagnosis of cleft lip/palate, leading to timely postnatal evaluation and treatment.
The impact of interhospital transfer on mortality benchmarking at Level III and IV trauma centers: A step toward shared mortality attribution in a statewide system
Authors: Holena Daniel N. , Kaufman Elinore J. , Hatchimonji Justin , Smith Brian P. , Xiong Ruiying , Wasser Thomas E. , Delgado M. Kit , Wiebe Douglas J. , Carr Brendan G. , Reilly Patrick M.
Published: September 2019

BACKGROUND

Many injured patients presenting to Level III/IV trauma centers will be transferred to Level I/II centers, but how these transfers influence benchmarking at Level III/IV centers has not been described. We hypothesized that the apparent observed to expected (O:E) mortality ratios at Level III/IV centers are influenced by the location at which mortality is measured in transferred patients.

METHODS

We conducted a retrospective study of adult patients presenting to Level III/IV trauma centers in Pennsylvania from 2008 to 2017. We used probabilistic matching to match patients transferred between centers. We used a risk-adjusted mortality model to estimate predicted mortality, which we compared with observed mortality at discharge from the Level III/IV center (O1) or observed mortality at discharge from the Level III/IV center for nontransferred patients and at discharge from the Level I/II center for transferred patients (O2).

RESULTS

In total, 9,477 patients presented to 11 Level III/IV trauma centers over the study period (90% white; 49% female; 97% blunt mechanism; median Injury Severity Score, 8; interquartile range, 4–10). Of these, 4,238 (44%) were transferred to Level I/II centers, of which 3,586 (85%) were able to be matched. Expected mortality in the overall cohort was 332 (3.8%). A total of 332 (3.8%) patients died, of which 177 (53%) died at the initial Level III/IV centers (O1). Including posttransfer mortality for transferred patients in addition to observed mortality in nontransferred patients (O2) resulted in worse apparent O:E ratios for all centers and significant differences in O:E ratios for the overall cohort (O1:E, 0.53; 95% confidence interval, 0.45–0.61 vs. O2:E, 1.00, 95% confidence interval, 0.92–1.11; p < 0.001).

CONCLUSION

Apparent O:E mortality ratios at Level III/IV centers are influenced by the timing of measurement. To provide fair and accurate benchmarking and identify opportunities across the continuum of the trauma system, a system of shared attribution for outcomes of transferred patients should be devised.
The impact of Medicaid expansion on trauma-related emergency department utilization: A national evaluation of policy implications
Authors: Knowlton Lisa Marie , Dehghan Melody S. , Arnow Katherine , Trickey Amber W. , Tennakoon Lakshika , Morris Arden M. , Spain David A.
Published: September 2019

BACKGROUND

The impact of the 2014 Affordable Care Act (ACA) upon national trauma-related emergency department (ED) utilization is unknown. We assessed ACA-related changes in ED use and payer mix, hypothesizing that post-ACA ED visits would decline and Medicaid coverage would increase disproportionately in regions of widespread policy adoption.

METHODS

We queried the National Emergency Department Sample (NEDS) for those with a primary trauma diagnosis, aged 18 to 64. Comparing pre-ACA (2012) to post-ACA (10/2014 to 09/2015), primary outcomes were change in ED visits and payer status; secondary outcomes were change in costs, discharge disposition and inpatient length of stay. Univariate and multivariate analyses were performed, including difference-in-differences analyses. We compared changes in ED trauma visits by payer in the West (91% in a Medicaid expansion state) versus the South (12%).

RESULTS

Among 21.2 million trauma-related ED visits, there was a 13.3% decrease post-ACA. Overall, there was a 7.2% decrease in uninsured ED visits (25.5% vs. 18.3%, p < 0.001) and a 6.6% increase in Medicaid coverage (17.6% vs. 24.2%, p < 0.001). Trauma patients had 40% increased odds of having Medicaid post-ACA (vs. pre-ACA: aOR 1.40, p < 0.001). Patients in the West had 31% greater odds of having Medicaid (vs. South: aOR 1.31, p < 0.001). The post-ACA increase in Medicaid was greater in the West (vs. South: aOR 1.60, p < 0.001). Post-ACA, inpatients were more likely to have Medicaid (vs. ED discharge: aOR 1.20, p < 0.001) and there was a 25% increase in inpatient discharge to rehabilitation (aOR 1.24, p < 0.001).

CONCLUSION

Post-ACA, there was a significant increase in insured trauma patients and a decrease in injury-related ED visits, possibly resulting from access to other outpatient services. Ensuring sustainability of expanded coverage will benefit injured patients and trauma systems.

LEVEL OF EVIDENCE

Economic, level III.