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Keller-Biehl L, Otoya D, Khader A, Timmerman W, Fernandez L, Amendola M. Just the gastrointestinal stromal tumor: A case report of medical modeling of a rectal gastrointestinal stromal tumor. SAGE Open Med Case Rep 2024; 12:2050313X231211124. [PMID: 38500559 PMCID: PMC10946069 DOI: 10.1177/2050313x231211124] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2023] [Accepted: 10/13/2023] [Indexed: 03/20/2024] Open
Abstract
A 54-year-old African-American male presented to the colorectal surgery clinic with the chief complaint of a painful anal swelling that had been ongoing for several weeks. An adequate rectal examination was not possible due to severe pain. Therefore, he was taken to the operating room for an exam under anesthesia where a presacral mass was identified. A transgluteal core needle biopsy was performed which was consistent with gastrointestinal stromal tumor. Computed tomography imaging identified a 16 cm ×10 cm ×9 cmrectal gastrointestinal stromal tumor. Given the size and location, the patient began treatment with neoadjuvant Imatinib. His progress was followed with serial computed tomography scans and clinic visits. A 3D model was created the tumor and surrounding structures to aide in pre- and intraoperative planning. The model was utilized during patient education and found to valuable in describing the potential for levator invasion and framing potential post-operative outcomes. The patient was able to undergo rectal preservation via a robotic low anterior resection with a transanal total mesorectal excision, coloanal anastomosis, and diverting ileostomy.
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Affiliation(s)
- Lucas Keller-Biehl
- School of Medicine, Virginia Commonwealth University, Richmond, VA, USA
- Department of Surgery, Central Virginia VA Health Care System, Richmond, VA, USA
| | - Diana Otoya
- School of Medicine, Virginia Commonwealth University, Richmond, VA, USA
- Department of Surgery, Central Virginia VA Health Care System, Richmond, VA, USA
| | - Adam Khader
- School of Medicine, Virginia Commonwealth University, Richmond, VA, USA
- Department of Surgery, Central Virginia VA Health Care System, Richmond, VA, USA
| | - William Timmerman
- School of Medicine, Virginia Commonwealth University, Richmond, VA, USA
- Department of Surgery, Central Virginia VA Health Care System, Richmond, VA, USA
| | - Leopoldo Fernandez
- School of Medicine, Virginia Commonwealth University, Richmond, VA, USA
- Department of Surgery, Central Virginia VA Health Care System, Richmond, VA, USA
| | - Michael Amendola
- School of Medicine, Virginia Commonwealth University, Richmond, VA, USA
- Department of Surgery, Central Virginia VA Health Care System, Richmond, VA, USA
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Yamaki T, Hatakeyama N, Murayama T, Funakura M, Hara T, Onodera S, Ito D, Yakufujiang M, Odaki M, Oka N, Kobayashi S. Prediction of voluntary movements of the upper extremities by resting state-brain regional glucose metabolism in patients with chronic severe brain injury: A pilot study. Hum Brain Mapp 2023; 44:3158-3167. [PMID: 36929226 PMCID: PMC10171500 DOI: 10.1002/hbm.26270] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2022] [Accepted: 02/24/2023] [Indexed: 03/18/2023] Open
Abstract
Confirmation of the exact voluntary movements of patients with disorder of consciousness following severe traumatic brain injury (TBI) is difficult because of the associated communication disturbances. In this pilot study, we investigated whether regional brain glucose metabolism assessed by 18 F-fluorodeoxyglucose positron emission tomography (FDG-PET) at rest could predict voluntary movement in severe TBI patients, particularly those with sufficient upper limb capacity to use communication devices. We visually and verbally instructed patients to clasp or open their hands. After video capture, three independent rehabilitation therapists determined whether the patients' movements were voluntary or involuntary. The results were compared with the standardized uptake value in the primary motor cortex, referring to the Penfield's homunculus, by resting state by FDG-PET imaged 1 year prior. Results showed that glucose uptake in the left (p = 0.0015) and right (p = 0.0121) proximal limb of the primary motor cortex, based on Penfield's homunculus on cerebral cartography, may reflect contralateral voluntary movement. Receiver operating characteristic curve analysis showed that a mean cutoff standardized uptake value of 5.47 ± 0.08 provided the best sensitivity and specificity for differentiating between voluntary and involuntary movements in each area. FDG-PET may be a useful and robust biomarker for predicting long-term recovery of motor function in severe TBI patients with disorders of consciousness.
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Affiliation(s)
- Tomohiro Yamaki
- Division of Neurosurgery, Rehabilitation Center for Traumatic Apallics Chiba, National Agency for Automotive Safety and Victims' Aid, 3-30-1 Isobe, Mihama-ku, Chiba, 261-0012, Japan.,Division of Radiology, Rehabilitation Center for Traumatic Apallics Chiba, National Agency for Automotive Safety and Victims' Aid, 3-30-1 Isobe, Mihama-ku, Chiba, 261-0012, Japan
| | - Naoya Hatakeyama
- Division of Rehabilitation, Rehabilitation Center for Traumatic Apallics Chiba, National Agency for Automotive Safety and Victims' Aid, 3-30-1 Isobe, Mihama-ku, Chiba, 261-0012, Japan
| | - Takemi Murayama
- Division of Rehabilitation, Rehabilitation Center for Traumatic Apallics Chiba, National Agency for Automotive Safety and Victims' Aid, 3-30-1 Isobe, Mihama-ku, Chiba, 261-0012, Japan
| | - Mika Funakura
- Division of Rehabilitation, Rehabilitation Center for Traumatic Apallics Chiba, National Agency for Automotive Safety and Victims' Aid, 3-30-1 Isobe, Mihama-ku, Chiba, 261-0012, Japan
| | - Takuya Hara
- Division of Rehabilitation, Rehabilitation Center for Traumatic Apallics Chiba, National Agency for Automotive Safety and Victims' Aid, 3-30-1 Isobe, Mihama-ku, Chiba, 261-0012, Japan
| | - Shinji Onodera
- Division of Radiology, Rehabilitation Center for Traumatic Apallics Chiba, National Agency for Automotive Safety and Victims' Aid, 3-30-1 Isobe, Mihama-ku, Chiba, 261-0012, Japan
| | - Daisuke Ito
- Division of Neurosurgery, Rehabilitation Center for Traumatic Apallics Chiba, National Agency for Automotive Safety and Victims' Aid, 3-30-1 Isobe, Mihama-ku, Chiba, 261-0012, Japan
| | - Maidinamu Yakufujiang
- Division of Neurosurgery, Rehabilitation Center for Traumatic Apallics Chiba, National Agency for Automotive Safety and Victims' Aid, 3-30-1 Isobe, Mihama-ku, Chiba, 261-0012, Japan
| | - Masaru Odaki
- Division of Neurosurgery, Rehabilitation Center for Traumatic Apallics Chiba, National Agency for Automotive Safety and Victims' Aid, 3-30-1 Isobe, Mihama-ku, Chiba, 261-0012, Japan
| | - Nobuo Oka
- Division of Neurosurgery, Rehabilitation Center for Traumatic Apallics Chiba, National Agency for Automotive Safety and Victims' Aid, 3-30-1 Isobe, Mihama-ku, Chiba, 261-0012, Japan.,Division of Radiology, Rehabilitation Center for Traumatic Apallics Chiba, National Agency for Automotive Safety and Victims' Aid, 3-30-1 Isobe, Mihama-ku, Chiba, 261-0012, Japan
| | - Shigeki Kobayashi
- Division of Neurosurgery, Rehabilitation Center for Traumatic Apallics Chiba, National Agency for Automotive Safety and Victims' Aid, 3-30-1 Isobe, Mihama-ku, Chiba, 261-0012, Japan
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Greenhalgh M, Kulich H, Blaauw E, Turner R, Peterson S, Cooper RA, Songer T. Health Outcomes Used to Determine Facets of Health-related Quality of Life for Post-9/11 Veterans Using Assistive Technology for A Combat-related Mobility Impairment: A Literature Review. Mil Med 2021; 186:1106-1114. [PMID: 33538791 DOI: 10.1093/milmed/usab028] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2020] [Revised: 08/11/2020] [Accepted: 01/21/2021] [Indexed: 11/14/2022] Open
Abstract
INTRODUCTION Novel rehabilitation methods, including distribution and adoption of assistive technology for lower extremity impairments, are becoming crucial to ensure positive quality of life in all individuals. The quality of life of post-9/11 combat veterans is not well understood, in comparison to research on other populations. The following essay describes a review on health outcomes used to determine health-related quality of life (HR-QoL) among combat-injured service members who require mobility-related assistive technology. MATERIALS AND METHODS Reviews pooled data from research on PubMed, EMBASE, CINAHL, and PsycINFO published after September 11, 2001, and included service members who sustained a mobility impairment because of involvement in a post-9/11 combat operation. Basic descriptors were extracted in addition to health outcomes used, which were then categorized and summarized by six domains for HR-QoL as defined by the World Health Organization. RESULTS This review found health outcomes that fit in the pain and discomfort, negative emotions, mobility, social relations, access to and quality of healthcare services, and religious/spiritual/personal beliefs subdomains. The categorized results detailed their application to track and model HR-QoL health states in those with mobility impairments using mobility-based assistive technology. CONCLUSIONS The research on combat-induced mobility impairments indicates assistive technology improves otherwise poor health states. The results model these domains and subdomains to determine overall HR-QoL and the quality of a healthcare intervention, though additional research is needed as only one study was identified to be experimental in design.
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Affiliation(s)
- Mark Greenhalgh
- Human Engineering Research Laboratories, Veterans Affairs Pittsburgh Healthcare System, Pittsburgh, PA 15206, USA.,School of Health and Rehabilitation Sciences, University of Pittsburgh, Pittsburgh, PA 15260, USA.,Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA 15261, USA
| | - Hailee Kulich
- Human Engineering Research Laboratories, Veterans Affairs Pittsburgh Healthcare System, Pittsburgh, PA 15206, USA.,School of Health and Rehabilitation Sciences, University of Pittsburgh, Pittsburgh, PA 15260, USA
| | - Eline Blaauw
- Human Engineering Research Laboratories, Veterans Affairs Pittsburgh Healthcare System, Pittsburgh, PA 15206, USA
| | - Rose Turner
- School of Health and Rehabilitation Sciences, University of Pittsburgh, Pittsburgh, PA 15260, USA.,Health Sciences Library, University of Pittsburgh, Pittsburgh, PA 15261, USA
| | - Sara Peterson
- School of Health and Rehabilitation Sciences, University of Pittsburgh, Pittsburgh, PA 15260, USA.,Department of Prosthetics and Orthotics, School of Health and Rehabilitation Sciences, University of Pittsburgh, Pittsburgh, PA 15206, USA
| | - Rory A Cooper
- Human Engineering Research Laboratories, Veterans Affairs Pittsburgh Healthcare System, Pittsburgh, PA 15206, USA.,School of Health and Rehabilitation Sciences, University of Pittsburgh, Pittsburgh, PA 15260, USA
| | - Thomas Songer
- Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA 15261, USA
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