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Hay ID, Lee RA, Reading CC, Charboneau JW. Can Ethanol Ablation Achieve Durable Control of Neck Nodal Recurrences in Adults With Stage I Papillary Thyroid Cancer? J Endocr Soc 2024; 8:bvae037. [PMID: 38505561 PMCID: PMC10949354 DOI: 10.1210/jendso/bvae037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2023] [Indexed: 03/21/2024] Open
Abstract
Objective Results of ethanol ablation (EA) for controlling neck nodal metastases (NNM) in adult patients with papillary thyroid carcinoma (APTC) beyond 6 months have rarely been reported. We now describe outcome results in controlling 71 NNM in 40 node-positive stage I APTC patients followed for 66 to 269 months. Methods All 40 patients were managed with bilateral thyroidectomy and radioiodine therapy and followed with neck ultrasound (US) for >48 months after EA. Cumulative radioiodine doses ranged from 30 to 550 mCi; pre-EA 27 patients (67%) had 36 additional neck surgeries. Cytologic diagnosis of PTC in 71 NNM selected for EA was confirmed by US-guided biopsy. EA technique and follow-up protocol were as previously described. Results The 40 patients had 1 to 4 NNM; 67/71 NNM (94%) received 2 to 4 ethanol injections (total median volume 0.8 cc). All ablated 71 NNM shrank (mean volume reduction of 93%); nodal hypervascularity was eliminated. Thirty-eight NNM (54%) with initial volumes of 12-1404 mm3 (median 164) disappeared on neck sonography. Thirty-three hypovascular foci from ablated NNM (pre-EA volume range 31-636 mm3; median 147) were still identifiable with volume reductions of 45% to 97% observed (median 81%). There were no complications and no postprocedure hoarseness. Final results were considered to be ideal or near ideal in 55% and satisfactory in 45%. There was no evidence of tumor regrowth after EA. Conclusion Our results demonstrate that for patients with American Joint Committee on Cancer stage I APTC, who do not wish further surgery or radioiodine, and are uncomfortable with active surveillance, EA can achieve durable control of recurrent NNM.
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Affiliation(s)
- Ian D Hay
- Department of Medicine, Mayo Clinic, Rochester, MN 55905, USA
| | - Robert A Lee
- Department of Radiology, Mayo Clinic, Rochester, MN 55905, USA
| | - Carl C Reading
- Department of Radiology, Mayo Clinic, Rochester, MN 55905, USA
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Crosby JC, Lee RA, McGwin G, Heath SL, Burkholder GA, Gravett RM, Overton ET, Locks G, Fleece ME, Franco R, Nafziger S. A COVID-19 monitoring process for healthcare workers utilizing occupational health. Occup Med (Lond) 2024; 74:71-77. [PMID: 37995321 PMCID: PMC10875928 DOI: 10.1093/occmed/kqad114] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2023] Open
Abstract
BACKGROUND Hospital-based occupational health (HBOH) is uniquely positioned to not only prevent severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) transmission, but to care for healthcare workers (HCWs) sick with coronavirus disease 2019 (COVID-19). AIMS The primary objective of this study is to describe a system where HBOH services were adapted to provide a monitoring programme whereby HCWs with SARS-CoV-2 received daily evaluations and treatment options in order to improve access to care, and to report the clinical outcomes and predictors of hospitalization in HCWs enrolled in the programme. A secondary objective is to compare clinical outcomes to data on national HCWs with COVID-19. METHODS This retrospective cohort study used survey data collected on HCWs at a university health system with COVID-19 from 1 March 2020 through 1 December 2021. A firth regression model was used to examine the unadjusted and adjusted association between clinical factors and hospitalization. RESULTS The study cohort included 4814 HCWs with COVID-19. Overall hospitalizations were 119 (2%), and there were six deaths (0.12%). Predictors of hospitalization include several co-morbidities and symptoms. A total of 1835 HCWs monitored before vaccine or monoclonal antibody availability were compared with data on U.S. HCWs in a similar time period. The monitored HCWs had a lower rate of co-morbidities (19% versus 44%, P < 0.001), a lower hospitalization rate (3% versus 8% P < 0.001) and case-fatality rate (0.11% versus 0.95% P < 0.001). CONCLUSIONS This monitoring strategy for COVID-19 may be feasible for HBOH systems to implement and improve access to care, but more data are needed to determine if it improves outcomes.
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Affiliation(s)
- J C Crosby
- Department of Emergency Medicine, Heersink School of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, 35233, USA
| | - R A Lee
- Department of Medicine, Division of Infectious Diseases, Heerskin School of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, 35233, USA
| | - G McGwin
- Department of Epidemiology, School of Public Health, University of Alabama at Birmingham, Birmingham, Alabama, 35233, USA
| | - S L Heath
- Department of Emergency Medicine, Heersink School of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, 35233, USA
| | - G A Burkholder
- Department of Medicine, Division of Infectious Diseases, Heerskin School of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, 35233, USA
| | - R M Gravett
- Department of Medicine, Division of Infectious Diseases, Heerskin School of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, 35233, USA
| | - E T Overton
- Department of Medicine, Division of Infectious Diseases, Heerskin School of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, 35233, USA
| | - G Locks
- UAB Employee Health, University of Alabama at Birmingham, Birmingham, Alabama, 35233, USA
| | - M E Fleece
- Department of Medicine, Division of Infectious Diseases, Heerskin School of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, 35233, USA
| | - R Franco
- Department of Medicine, Division of Infectious Diseases, Heerskin School of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, 35233, USA
| | - S Nafziger
- Department of Health Policy and Organization, School of Public Health, University of Alabama at Birmingham, Birmingham, Alabama, 35233, USA
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Fatourechi V, Swanson AA, Lee RA. Stable thyroid cancer in a patient with thoracic aortic aneurysm and MYH11 variation. Endocrinol Diabetes Metab Case Rep 2024; 2024:23-0088. [PMID: 38189791 PMCID: PMC10831535 DOI: 10.1530/edm-23-0088] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2023] [Accepted: 11/29/2023] [Indexed: 01/09/2024] Open
Abstract
Summary We report the case of a male patient with papillary thyroid cancer, familial thoracic aortic aneurysm and dissection, and a variation in the MYH11 gene. Because of considerable tumor bulk in the neck that was not resectable, the patient underwent partial resection at age 14 years. Since then, the patient has received only suppressive thyroid hormone therapy. He is now 71 years old, which is 57 years after the initial resection. The patient received care at our institution from July 2009 to August 2019, during which we documented the stability of multiple calcified masses in the neck. Follow-up examinations at another institution from September 2019 to April 2023 also confirmed the stability of the masses. The underlying cause of this unusually long indolent course of the disease is unclear. Whether extensive tumor calcifications or the MYH11 sequence variation contributed to the disease course is also uncertain. Learning points Papillary thyroid cancer with neck metastases may, in some cases, be stable and remain asymptomatic for decades. If locoregional stability of papillary thyroid cancer is documented for many years, observation may be preferable to extensive neck surgery in selected cases. This is the first report of an MYH11 gene alteration and thoracic aortic aneurysm in a patient with papillary thyroid cancer with indolent neck metastases. Future studies of MYH11 gene alterations in thyroid carcinoma are needed.
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Affiliation(s)
- Vahab Fatourechi
- Division of Endocrinology, Diabetes, Metabolism, and Nutrition, Mayo Clinic, Rochester, Minnesota, USA
| | - Amy A Swanson
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota, USA
| | - Robert A Lee
- Department of Radiology, Mayo Clinic, Rochester, Minnesota, USA
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Maldonado AA, Oishi T, Lee RA, Spinner RJ. Intraoperative Biceps/Brachialis Stimulation for Snapping Triceps With Ulnar Neuritis. Oper Neurosurg (Hagerstown) 2023; 25:e108-e112. [PMID: 37255297 DOI: 10.1227/ons.0000000000000762] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2023] [Accepted: 03/19/2023] [Indexed: 06/01/2023] Open
Abstract
BACKGROUND AND IMPORTANCE Snapping of the triceps muscle occurs when a portion of the medial head dislocates over the medial epicondyle with elbow flexion. Resection or redirection of a portion of the triceps muscle is the main surgical treatment. The extent of triceps resection/redirection is difficult to evaluate. A novel intraoperative technique, stimulating the musculocutaneous nerve, to simulate active elbow flexion is proposed to help ensure that the snapping triceps has been adequately treated. CLINICAL PRESENTATION A patient presented with a several year history of bilateral elbow pain, snapping, and ulnar nerve (UN) paresthesias. Previous staged bilateral subcutaneous UN transpositions were performed at another institution for documented UN dislocation and neuritis. Postoperatively symptoms of painful snapping persisted. Bilateral snapping triceps was diagnosed. The left elbow was reoperated. Intraoperative electrical stimulation of the musculocutaneous nerve was performed to reproduce the snapping triceps. Activation of the biceps/brachialis muscles produced powerful elbow flexion, allowed direct visualization of the forceful snapping triceps, and helped assess the adequacy of muscle resection/redirection. CONCLUSION Intraoperative biceps/brachialis stimulation can potentially help determine how much triceps muscle should be resected/redirected to treat patients with snapping triceps.
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Affiliation(s)
- Andres A Maldonado
- Departments of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Tatsuya Oishi
- Departments of Neurology, Mayo Clinic, Rochester, Minnesota, USA
| | - Robert A Lee
- Departments of Radiology, Mayo Clinic, Rochester, Minnesota, USA
| | - Robert J Spinner
- Departments of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota, USA
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Hay ID, Lee RA, Reading CC, Pittock ST, Sharma A, Thompson GB, William Charboneau J. Long-term Effectiveness of Ethanol Ablation in Controlling Neck Nodal Metastases in Childhood Papillary Thyroid Cancer. J Endocr Soc 2023; 7:bvad065. [PMID: 37388573 PMCID: PMC10306272 DOI: 10.1210/jendso/bvad065] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2022] [Indexed: 07/01/2023] Open
Abstract
Context Childhood papillary thyroid carcinoma (CPTC), despite bilateral thyroidectomy, nodal dissection and radioiodine remnant ablation (RRA), recurs within neck nodal metastases (NNM) in 33% within 20 postoperative years. These NNM are usually treated with reoperation or further radioiodine. Ethanol ablation (EA) may be considered when numbers of NNM are limited. Objective We studied the long-term results of EA in 14 patients presenting with CPTC during 1978 to 2013 and having EA for NNM during 2000 to 2018. Methods Cytologic diagnoses of 20 NNM (median diameter 9 mm; median volume 203 mm3) were biopsy proven. EA was performed during 2 outpatient sessions under local anesthesia; total volume injected ranged from 0.1 to 2.8 cc (median 0.7). All were followed regularly by sonography and underwent volume recalculation and intranodal Doppler flow measurements. Successful ablation required reduction both in NNM volume and vascularity. Results Post EA, patients were followed for 5 to 20 years (median 16). There were no complications, including postprocedure hoarseness. All 20 NNM shrank (mean by 87%) and Doppler flow eliminated in 19 of 20. After EA, 11 NNM (55%) disappeared on sonography; 8 of 11 before 20 months. Nine ablated foci were still identifiable after a median of 147 months; only one identifiable 5-mm NNM retained flow. Median serum Tg post EA was 0.6 ng/mL. Only one patient had an increase in Tg attributed to lung metastases. Conclusion EA of NNM in CPTC is effective and safe. Our results suggest that for CPTC patients who do not wish further surgery and are uncomfortable with active surveillance of NNM, EA represents a minimally invasive outpatient management option.
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Affiliation(s)
- Ian D Hay
- Correspondence: Ian D. Hay, MD, PhD, FRSE, Division of Endocrinology, Department of Internal Medicine, Mayo Clinic College of Medicine, 200 First St SW, Rochester, MN 55905, USA.
| | - Robert A Lee
- Department of Radiology, Mayo Clinic, Rochester, MN 55905, USA
| | - Carl C Reading
- Department of Radiology, Mayo Clinic, Rochester, MN 55905, USA
| | | | - Animesh Sharma
- Department of Pediatric Endocrinology, Children’s Hospital, Aurora, CO 80045, USA
| | - Geoffrey B Thompson
- Department of Surgery, Sheikh Shakhbout Medical City, PO Box 11001, Abu Dhabi, United Arab Emirates
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Navin PJ, Thompson SM, Kurup AN, Lee RA, Callstrom MR, Castro MR, Stan MN, Welch BT, Schmitz JJ. Radiofrequency Ablation of Benign and Malignant Thyroid Nodules. Radiographics 2022; 42:1812-1828. [DOI: 10.1148/rg.220021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Affiliation(s)
- Patrick J. Navin
- From the Departments of Radiology (P.J.N., S.M.T., A.N.K., R.A.L., M.R.C., B.T.W., J.J.S.) and Endocrinology (M.R.C., M.N.S.), Mayo Clinic, 200 1st St SW, Rochester, MN 55905-0002
| | - Scott M. Thompson
- From the Departments of Radiology (P.J.N., S.M.T., A.N.K., R.A.L., M.R.C., B.T.W., J.J.S.) and Endocrinology (M.R.C., M.N.S.), Mayo Clinic, 200 1st St SW, Rochester, MN 55905-0002
| | - Anil N. Kurup
- From the Departments of Radiology (P.J.N., S.M.T., A.N.K., R.A.L., M.R.C., B.T.W., J.J.S.) and Endocrinology (M.R.C., M.N.S.), Mayo Clinic, 200 1st St SW, Rochester, MN 55905-0002
| | - Robert A. Lee
- From the Departments of Radiology (P.J.N., S.M.T., A.N.K., R.A.L., M.R.C., B.T.W., J.J.S.) and Endocrinology (M.R.C., M.N.S.), Mayo Clinic, 200 1st St SW, Rochester, MN 55905-0002
| | - Matthew R. Callstrom
- From the Departments of Radiology (P.J.N., S.M.T., A.N.K., R.A.L., M.R.C., B.T.W., J.J.S.) and Endocrinology (M.R.C., M.N.S.), Mayo Clinic, 200 1st St SW, Rochester, MN 55905-0002
| | - M. Regina Castro
- From the Departments of Radiology (P.J.N., S.M.T., A.N.K., R.A.L., M.R.C., B.T.W., J.J.S.) and Endocrinology (M.R.C., M.N.S.), Mayo Clinic, 200 1st St SW, Rochester, MN 55905-0002
| | - Marius N. Stan
- From the Departments of Radiology (P.J.N., S.M.T., A.N.K., R.A.L., M.R.C., B.T.W., J.J.S.) and Endocrinology (M.R.C., M.N.S.), Mayo Clinic, 200 1st St SW, Rochester, MN 55905-0002
| | - Brian T. Welch
- From the Departments of Radiology (P.J.N., S.M.T., A.N.K., R.A.L., M.R.C., B.T.W., J.J.S.) and Endocrinology (M.R.C., M.N.S.), Mayo Clinic, 200 1st St SW, Rochester, MN 55905-0002
| | - John J. Schmitz
- From the Departments of Radiology (P.J.N., S.M.T., A.N.K., R.A.L., M.R.C., B.T.W., J.J.S.) and Endocrinology (M.R.C., M.N.S.), Mayo Clinic, 200 1st St SW, Rochester, MN 55905-0002
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Hay ID, Lee RA, Charboneau JW. Efficacy of Ethanol Ablation in Long-Term Local Control of Neck Nodal Metastases in Adult Papillary Thyroid Carcinoma. J Clin Endocrinol Metab 2022; 107:e2636-e2637. [PMID: 35030635 PMCID: PMC9113796 DOI: 10.1210/clinem/dgac018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2022] [Indexed: 11/19/2022]
Affiliation(s)
- Ian D Hay
- Department of Medicine, Mayo Clinic College of Medicine, Rochester, MN 55905, USA
- Correspondence: Ian D. Hay, M.D. Ph.D., Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA,
| | - Robert A Lee
- Department of Radiology, Mayo Clinic College of Medicine, Rochester, MN 55905, USA
| | - J William Charboneau
- Department of Radiology, Mayo Clinic College of Medicine, Rochester, MN 55905, USA
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Hon SA, Lee LT, Tan KK, Lee RA, Low QJ. Hepatic Sarcoidosis: Diagnostic approach and management. Med J Malaysia 2021; 76:914-917. [PMID: 34806684] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
Sarcoidosis is a multi-systemic, non-caseating granulomatous disorder with an idiopathic aetiology. We report a 58-year-old Malay woman, with underlying type II diabetes mellitus, hypertension and history of stage II pulmonary sarcoidosis presenting with incidental finding of multiple hypodense liver lesions. Her recent contrasted enhanced computed tomography of the abdomen and pelvis demonstrated multiple intra-abdominal lymphadenopathies with evidence of liver and splenic infiltrations. Her ageappropriate malignancy screening was negative while liver biopsy showed non-caseating granulomatous hepatitis consistent with hepatic sarcoidosis. In view of her normal liver enzymes and normalised serum calcium levels, no immunosuppressive therapy was commenced. She remains asymptomatic and is currently under our close monitoring.
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Affiliation(s)
- S A Hon
- Hospital Sultanah Nora Ismail, Department of Internal Medicine, Batu Pahat, Johor, Malaysia.
| | - L T Lee
- Hospital Sultanah Aminah, Department of Surgery, Johor Bahru, Johor, Malaysia
| | - K K Tan
- Hospital Pakar Sultanah Fatimah, Department of Pathology, Muar, Johor, Malaysia
| | - R A Lee
- Hospital Sultanah Nora Ismail, Department of Radiology, Batu Pahat, Johor, Malaysia
| | - Q J Low
- Hospital Sultanah Nora Ismail, Department of Internal Medicine, Batu Pahat, Johor, Malaysia
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Low QJ, Lau WK, Lim TH, Lee RA, Cheo SW. A Case of Severe Falciparum Malaria in a Returned Traveler. Malays Fam Physician 2020; 15:86-89. [PMID: 33329868 PMCID: PMC7735881] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
Primary care providers should be alert to travel-related infections. Around 10-40% of returning travelers from all destinations and 15-70% of travelers from tropical settings experience ill health, either overseas or upon returning home.1 A systematic approach concentrating on possible infections should be undertaken based on the patient's travel location, immunization history, presence of malaria chemoprophylaxis at the destination, other potential exposures, incubation period, and clinical presentation.2-3 The World Health Organization (WHO) website is constantly being updated on specific travel-related infections and recent geographical outbreaks. In this paper, we report a case of severe falciparum malaria in a returned traveler.
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Affiliation(s)
- Q J Low
- MD (UMS), MRCP (UK), Department of Internal Medicine, Hospital Sultanah Nora Ismail, Jalan Korma, Taman Soga, 83000, Batu Pahat, Johor, Malaysia, Email : lowqinjian@moh,gov.my
| | - W K Lau
- MBBS (UTAR), Department of Internal Medicine, Hospital Sultanah Nora Ismail, Jalan Korma, Taman Soga, 83000, Batu Pahat, Johor, Malaysia
| | - T H Lim
- MD (I.M. Sechenov Moscow Medical Academy), MRCP (UK), Department of Internal Medicine, Hospital Sultanah Nora Ismail, Jalan Korma, Taman Soga, 83000, Batu Pahat, Johor, Malaysia
| | - R A Lee
- MBBS (UM), M.Med (Rad), FRCR (UK) Department of Radiology, Hospital Sultanah Nora Ismail, Jalan Korma, Taman Soga, 83000, Batu Pahat, Johor, Malaysia
| | - S W Cheo
- MD (UMS), MRCP (UK), Department of Internal Medicine, Hospital Lahad Datu, Peti Bersurat 60065, 91110, Lahad Datu, Sabah Malaysia
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Affiliation(s)
- Q J Low
- Department of Internal Medicine, Hospital Sultanah Nora Ismail, Jalan Korma, Taman Soga, Batu Pahat, Johor 83000, Malaysia
| | - S A Hon
- Department of Internal Medicine, Hospital Sultanah Nora Ismail, Jalan Korma, Taman Soga, Batu Pahat, Johor 83000, Malaysia
| | - P W Garry Siow
- Department of Internal Medicine, Hospital Sultanah Nora Ismail, Jalan Korma, Taman Soga, Batu Pahat, Johor 83000, Malaysia
| | - T H Lim
- Department of Internal Medicine, Hospital Sultanah Nora Ismail, Jalan Korma, Taman Soga, Batu Pahat, Johor 83000, Malaysia
| | - R A Lee
- Department of Radiology, Hospital Sultanah Nora Ismail, Jalan Korma, Taman Soga, Batu Pahat, Johor 83000, Malaysia
| | - Y A Tan
- Department of Internal Medicine, Hospital Queen Elizabeth, Kota Kinabalu, Sabah 88300, Malaysia
| | - S W Cheo
- Department of Internal Medicine, Hospital Lahad Datu, Peti Bersurat 60065, Lahad Datu, Sabah 91110, Malaysia
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Hay ID, Lee RA, Kaggal S, Morris JC, Stan MN, Castro MR, Fatourechi V, Thompson GB, Charboneau JW, Reading CC. Long-Term Results of Treating With Ethanol Ablation 15 Adult Patients With cT1aN0 Papillary Thyroid Microcarcinoma. J Endocr Soc 2020; 4:bvaa135. [PMID: 33073159 PMCID: PMC7543935 DOI: 10.1210/jendso/bvaa135] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2020] [Accepted: 09/11/2020] [Indexed: 12/13/2022] Open
Abstract
Background Currently acceptable management options for patients with adult papillary thyroid microcarcinoma (APTM) range from immediate surgery, either unilateral lobectomy or bilateral lobar resection, to active surveillance (AS). An alternative minimally invasive approach, originally employed for eliminating neck nodal metastases, may be ultrasound-guided percutaneous ethanol ablation (EA). Here we present our experience of definitively treating with EA 15 patients with APTM. Patients and Methods During 2010 through 2017, the 15 cT1aN0M0 patients selected for EA were aged 36 to 86 years (median, 45 years). Tumor volumes (n = 17), assessed by sonography, ranged from 25 to 375 mm3 (median, 109 mm3). Fourteen of 15 patients had 2 ethanol injections on successive days; total volume injected ranged from 0.45 to 1.80 cc (median, 1.1 cc). All ablated patients were followed with sonography and underwent recalculation of tumor volume and reassessment of tumor perfusion at each follow-up visit. Results The ablated patients have now been followed for 10 to 100 months (median, 64 months). There were no complications and no ablated patient developed postprocedure recurrent laryngeal nerve dysfunction. All 17 ablated tumors shrank (median 93%) and Doppler flow eliminated. Median tumor volume reduction in 9 identifiable avascular foci was 82% (range, 26%-93%). After EA, 8 tumors (47%) disappeared on sonography after a median of 10 months. During follow-up no new PTM foci and no nodal metastases have been identified. Conclusions Definitive treatment of APTM by EA is effective, safe, and inexpensive. Our results suggest that, for APTM patients who do not wish neck surgery and are uncomfortable with AS, EA represents a well-tolerated and minimally invasive outpatient management option.
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Affiliation(s)
- Ian D Hay
- Departments of Medicine, Mayo Clinic College of Medicine, Rochester, Minnesota, USA
| | - Robert A Lee
- Departments of Radiology, Mayo Clinic College of Medicine, Rochester, Minnesota, USA
| | - Suneetha Kaggal
- Departments of Health Sciences Research, Mayo Clinic College of Medicine, Rochester, Minnesota, USA
| | - John C Morris
- Departments of Medicine, Mayo Clinic College of Medicine, Rochester, Minnesota, USA
| | - Marius N Stan
- Departments of Medicine, Mayo Clinic College of Medicine, Rochester, Minnesota, USA
| | - M Regina Castro
- Departments of Medicine, Mayo Clinic College of Medicine, Rochester, Minnesota, USA
| | - Vahab Fatourechi
- Departments of Medicine, Mayo Clinic College of Medicine, Rochester, Minnesota, USA
| | - Geoffrey B Thompson
- Departments of Surgery, Mayo Clinic College of Medicine, Rochester, Minnesota, USA
| | - J William Charboneau
- Departments of Radiology, Mayo Clinic College of Medicine, Rochester, Minnesota, USA
| | - Carl C Reading
- Departments of Radiology, Mayo Clinic College of Medicine, Rochester, Minnesota, USA
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Affiliation(s)
| | - C Siaw
- Department of Internal Medicine, Hospital Sultanah Nora Ismail, Jalan Korma, Taman Soga, 83000 Batu Pahat, Johor, Malaysia
| | - R A Lee
- Department of Radiology, Hospital Sultanah Nora Ismail, Jalan Korma, Taman Soga, 83000 Batu Pahat, Johor, Malaysia
| | - S W Cheo
- Department of Internal Medicine, Hospital Lahad Datu, Peti Bersurat 60065, 91110 Lahad Datu, Sabah, Malaysia
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Iñiguez-Ariza NM, Lee RA, Brewer JD, Hay ID. Elimination of Locoregional Recurrences and Skin Metastases in Papillary Thyroid Cancer by Ethanol Ablation and Mohs Surgery. J Endocr Soc 2020; 4:bvaa095. [PMID: 32803095 PMCID: PMC7417876 DOI: 10.1210/jendso/bvaa095] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2020] [Accepted: 07/04/2020] [Indexed: 12/19/2022] Open
Abstract
Ultrasound-guided percutaneous ethanol ablation procedures for locoregional recurrences in papillary thyroid carcinoma (PTC) can be repeatedly performed over years. Skin metastases (SM) from PTC generally portend a lethal prognosis. Our patient case report demonstrates the innovative use in low-risk PTC (LRPTC) of treatment modalities designed to prevent neck re-explorations and capable of eliminating both locoregional recurrences and SM. In 2004, a 48-year-old man presented with neck nodal metastases due to PTC. He underwent a near-total thyroidectomy and nodal dissection, confirming an 8-mm PTC involving 2 ipsilateral node metastases. Postoperatively, he received 2 doses of radioactive iodine (RAI) for remnant uptake (cumulative dose 338 mCi); posttherapy scanning was unrevealing. In 2007, he underwent right neck dissection for further node metastases. In 2008, a guided biopsy confirmed a level IV node metastasis. He was referred to our institution for ethanol ablation. Two node metastases were ablated and subsequently disappeared. During 2010-2016, he developed an additional 6 node metastases, which were treated with ethanol ablation; all disappeared on high-resolution sonography. FDG-PET-CT scans in 2009 and 2016 were negative for distant spread. In 2016, a SM in his right neck was removed by dermatologic surgery. In 2017-2018, 2 further SM were excised with negative margins, one after Mohs surgery. He has now been disease-free for 20 months. In conclusion, despite 3 neck surgeries and 2 RAI therapies, our patient repeatedly developed both locoregional recurrences and SM. All 11 disease foci were eliminated with minimally invasive procedures which should more often be considered as effective treatment options in LRPTC.
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Affiliation(s)
- Nicole M Iñiguez-Ariza
- Division of Endocrinology, Department of Internal Medicine, Mayo Clinic and College of Medicine, Rochester, Minnesota
| | - Robert A Lee
- Department of Radiology, Mayo Clinic and College of Medicine, Rochester, Minnesota
| | - Jerry D Brewer
- Department of Dermatology, Mayo Clinic and College of Medicine, Rochester, Minnesota
| | - Ian D Hay
- Division of Endocrinology, Department of Internal Medicine, Mayo Clinic and College of Medicine, Rochester, Minnesota
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Strajina V, Dy BM, McKenzie TJ, Al-Hilli Z, Lee RA, Ryder M, Farley DR, Thompson GB, Lyden ML. Treatment of lateral neck papillary thyroid carcinoma recurrence after selective lateral neck dissection. Surgery 2018; 165:31-36. [PMID: 30314726 DOI: 10.1016/j.surg.2018.04.063] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2018] [Revised: 04/02/2018] [Accepted: 04/07/2018] [Indexed: 02/05/2023]
Abstract
BACKGROUND There is a paucity of data regarding optimal treatment options and outcomes for recurrent disease after lateral neck dissection in patients with papillary thyroid carcinoma. METHODS Retrospective review of patients who underwent either percutaneous ethanol injection or surgery for first-time ipsilateral recurrences after ipsilateral lateral neck dissection for papillary thyroid carcinoma was performed. RESULTS Follow-up data were available for 54 patients with recurrences in 57 lateral necks treated by either percutaneous ethanol injection (n = 32) or surgery (n = 25). Tumor burden at the time of lateral neck recurrence differed between the groups including the largest lymph node diameter (mean: 13 mm vs 18 mm, P < .01) and the mean number of metastatic lymph nodes identified on ultrasound (1.3 vs 1.9, P = .04). Each modality alone achieved similar estimated rates of disease control at 36 months (75% for percutaneous ethanol injection and 74% for surgery, P = .8) with similar number of reinterventions (1.8 for percutaneous ethanol injection, 1.6 for surgery, P = .6). CONCLUSIONS Both ethanol ablation and surgery can achieve disease control in the majority of patients with recurrences after ipsilateral lateral neck dissection for papillary thyroid carcinoma. Ethanol ablation, when used for treatment of a single small lymph node, can result in outcomes that are similar to reoperative surgery for larger and multiple lymph nodes.
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Affiliation(s)
| | - Benzon M Dy
- Department of Surgery, Mayo Clinic, Rochester, Minnesota
| | | | | | - Robert A Lee
- Department of Radiology, Mayo Clinic, Rochester, Minnesota
| | - Mabel Ryder
- Division of Endocrinology, Metabolism, Nutrition & Diabetes, Mayo Clinic, Rochester, Minnesota
| | - David R Farley
- Department of Surgery, Mayo Clinic, Rochester, Minnesota
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Hamidi O, Callstrom MR, Lee RA, Dean D, Castro MR, Morris JC, Stan MN. In Reply-Radiofrequency Ablation Therapy for Large Benign Thyroid Nodules. Mayo Clin Proc 2018; 93:1328-1329. [PMID: 30193678 DOI: 10.1016/j.mayocp.2018.05.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2018] [Accepted: 05/10/2018] [Indexed: 12/15/2022]
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Iñiguez-Ariza NM, Lee RA, Singh-Ospina NM, Stan MN, Castro MR. Ethanol Ablation for the Treatment of Cystic and Predominantly Cystic Thyroid Nodules. Mayo Clin Proc 2018; 93:1009-1017. [PMID: 30078409 DOI: 10.1016/j.mayocp.2018.05.020] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2018] [Revised: 05/01/2018] [Accepted: 05/24/2018] [Indexed: 11/24/2022]
Abstract
OBJECTIVE To determine the efficacy and safety of percutaneous ethanol injection (PEI) for the treatment of symptomatic cystic thyroid nodules. PATIENTS AND METHODS Retrospective analysis of patients with benign cystic thyroid nodules treated with PEI from February 1, 2000, through October 31, 2016. The main outcomes were efficacy, defined as symptom relief or reduction in nodule volume of 50% or more, and safety, defined as no or minor adverse events. RESULTS Twenty patients had PEI. Mean age at the time of PEI was 50 years, and 13 (65%) were women; all patients were euthyroid. Twelve patients (60%) had complex cystic thyroid nodules (>50% cystic component), with the rest being purely cystic. The median largest diameter of the thyroid cyst was 4.5 cm (interquartile range [IQR], 3.2-5.3 cm; range, 2.3-8.0 cm); the median volume pre-PEI was 19.6 mL (IQR, 10.4-48.5 mL; range, 2.8-118.1 mL). The median amount of cystic fluid drained before PEI was 13.5 mL (IQR, 6.8-32.3 mL), and the median amount of ethanol administered was 3 mL (IQR, 2-5 mL; range, 0.5-20 mL). After median follow-up of 2 years, 17 of 19 patients (89%) were asymptomatic. Of 10 patients with available imaging on follow-up, 7 (70%) had a 50% or greater reduction in nodule volume (median volume decrease, 75.64% [IQR, 41.40%-91.99%]). Adverse effects occurred in 4 patients (20%) and were mild and temporary (slight pain, vagal reaction, and bleeding into the cyst). CONCLUSION Percutaneous ethanol injection seems to be a safe and effective alternative to surgical resection for patients with purely or predominantly cystic thyroid nodules and compressive symptoms who decline surgery or are not good surgical candidates.
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Affiliation(s)
- Nicole M Iñiguez-Ariza
- Division of Endocrinology, Diabetes, Metabolism, and Nutrition, Mayo Clinic, Rochester, MN; Department of Endocrinology and Metabolism, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - Robert A Lee
- Division of Radiology, Mayo Clinic, Rochester, MN
| | - Naykky M Singh-Ospina
- Division of Endocrinology, Department of Medicine, University of Florida, Gainesville
| | - Marius N Stan
- Division of Endocrinology, Diabetes, Metabolism, and Nutrition, Mayo Clinic, Rochester, MN
| | - M Regina Castro
- Division of Endocrinology, Diabetes, Metabolism, and Nutrition, Mayo Clinic, Rochester, MN.
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Hamidi O, Callstrom MR, Lee RA, Dean D, Castro MR, Morris JC, Stan MN. Outcomes of Radiofrequency Ablation Therapy for Large Benign Thyroid Nodules: A Mayo Clinic Case Series. Mayo Clin Proc 2018; 93:1018-1025. [PMID: 29572016 DOI: 10.1016/j.mayocp.2017.12.011] [Citation(s) in RCA: 44] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2017] [Revised: 11/08/2017] [Accepted: 12/13/2017] [Indexed: 11/19/2022]
Abstract
OBJECTIVE To assess the effectiveness, tolerability, and complications of radiofrequency ablation (RFA) in patients with benign large thyroid nodules (TNs). PATIENTS AND METHODS This is a retrospective review of 14 patients with predominantly solid TNs treated with RFA at Mayo Clinic in Rochester, Minnesota, from December 1, 2013, through October 30, 2016. All the patients declined surgery or were poor surgical candidates. The TNs were benign on fine-needle aspiration, enlarging or causing compressive symptoms, and 3 cm or larger in largest diameter. We evaluated TN volume, compressive symptoms, cosmetic concerns, and thyroid function. RESULTS Median TN volume reduction induced by RFA was 44.6% (interquartile range [IQR], 42.1%-59.3%), from 24.2 mL (IQR, 17.7-42.5 mL) to 14.4 mL (IQR, 7.1-19.2 mL) (P<.001). Median follow-up was 8.6 months (IQR, 3.9-13.9 months). Maximum results were achieved by 6 months. Radiofrequency ablation did not affect thyroid function. In 1 patient with subclinical hyperthyroidism due to toxic adenoma, thyroid function normalized 4 months after ablation of the toxic nodule. Compressive symptoms resolved in 8 of 12 patients (67%) and improved in the other 4 (33%). Cosmetic concerns improved in all 8 patients. The procedure had no sustained complications. CONCLUSION In this population, RFA of benign large TNs performed similarly to the reports from Europe and Asia. It induces a substantial volume reduction of predominantly solid TNs, improves compressive symptoms and cosmetic concerns, and does not affect normal thyroid function. Radiofrequency ablation has an acceptable safety profile and should be considered as a low-risk alternative to conventional treatment of symptomatic benign TNs.
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Affiliation(s)
- Oksana Hamidi
- Division of Endocrinology, Diabetes, Metabolism, and Nutrition, Mayo Clinic, Rochester, MN
| | | | - Robert A Lee
- Department of Radiology, Mayo Clinic, Rochester, MN
| | - Diana Dean
- Division of Endocrinology, Diabetes, Metabolism, and Nutrition, Mayo Clinic, Rochester, MN
| | - M Regina Castro
- Division of Endocrinology, Diabetes, Metabolism, and Nutrition, Mayo Clinic, Rochester, MN
| | - John C Morris
- Division of Endocrinology, Diabetes, Metabolism, and Nutrition, Mayo Clinic, Rochester, MN
| | - Marius N Stan
- Division of Endocrinology, Diabetes, Metabolism, and Nutrition, Mayo Clinic, Rochester, MN.
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Valesano JC, Schmitz JJ, Kurup AN, Schmit GD, Moynagh MR, Atwell TD, Lewis BD, Lee RA, Callstrom MR. Outcomes of Ultrasound-Guided Thrombin Injection of Nongroin Arterial Pseudoaneurysms. J Vasc Interv Radiol 2017; 28:1156-1160. [PMID: 28578990 DOI: 10.1016/j.jvir.2017.05.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2017] [Revised: 05/01/2017] [Accepted: 05/01/2017] [Indexed: 11/26/2022] Open
Abstract
PURPOSE To evaluate success and complication rates of percutaneous ultrasound-guided thrombin injection of nongroin pseudoaneurysms (PSAs). MATERIALS AND METHODS Retrospective review of a prospectively maintained institutional database yielded 39 cases of arterial PSAs occurring at nongroin sites that were treated with percutaneous ultrasound-guided thrombin injection between 2000 and 2016 (average patient age 69.2 y ± 14.0). Of PSAs, 74.4% (29/39) arose in the upper extremities, and 92.3% (36/39) were iatrogenic. The brachial artery was the most commonly affected vessel (51.3% [20/39]), and arterial access was the most common cause (56.4% [22/39]). Average overall PSA size was 2.4 cm (range, 0.5-7.2 cm); average amount of thrombin injected was 320 IU (range, 50-2,000 IU). Technical success was defined as absence of flow within the PSA immediately after thrombin injection. Treatment success was defined as sustained thrombosis on follow-up imaging obtained at 1-3 days after treatment. RESULTS Technical and treatment success rates of thrombin injections were 100% (39/39) and 84.8% (28/33), respectively. Longer term follow-up imaging (average 71 d; range, 12-201 d) was available for 7 of the treatment successes with 100% (7/7) showing sustained thrombosis. Comparing treatment successes and failures, there was no significant difference in average PSA size (2.3 cm vs 2.0 cm, P = .51) or average amount of thrombin injected (360 IU vs 180 IU, P = .14). There were no complications. CONCLUSIONS Ultrasound-guided thrombin injection is a safe, efficacious treatment option for PSAs arising in nongroin locations.
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Affiliation(s)
| | - John J Schmitz
- Department of Radiology, Mayo Clinic, 200 First Street SW, Rochester, MN 55905
| | - A Nicholas Kurup
- Department of Radiology, Mayo Clinic, 200 First Street SW, Rochester, MN 55905
| | - Grant D Schmit
- Department of Radiology, Mayo Clinic, 200 First Street SW, Rochester, MN 55905
| | - Michael R Moynagh
- Department of Radiology, Mayo Clinic, 200 First Street SW, Rochester, MN 55905
| | - Thomas D Atwell
- Department of Radiology, Mayo Clinic, 200 First Street SW, Rochester, MN 55905
| | - Bradley D Lewis
- Department of Radiology, Mayo Clinic, 200 First Street SW, Rochester, MN 55905
| | - Robert A Lee
- Department of Radiology, Mayo Clinic, 200 First Street SW, Rochester, MN 55905
| | - Matthew R Callstrom
- Department of Radiology, Mayo Clinic, 200 First Street SW, Rochester, MN 55905
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Beutler BD, Lee RA, Cohen PR. Localized cutaneous argyria: Report of two patients and literature review. Dermatol Online J 2016; 22:13030/qt4wm1j7pt. [PMID: 28329568] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2016] [Accepted: 11/16/2016] [Indexed: 06/06/2023] Open
Abstract
BackgroundLocalized cutaneous argyria is a rare skin condition caused by direct contact with silver or silver particles. It presents as asymptomatic gray or blue-gray macules that appear similar to blue nevi. Histologic features include brown-colored or black-colored silver granules in the basement membrane and dermis, most commonly surrounding eccrine glands, elastic fibers, and collagen fibrils. The condition is most frequently observed in individuals who are regularly exposed to small silver particles, such as silversmiths and welders. However, localized cutaneous argyria has also been associated with acupuncture needles, silver earrings, and topical medications containing silver nitrate. Although the condition is benign, patients who are concerned about the cosmetic features of localized cutaneous argyria may benefit from laser therapy.PurposeWe describe the clinical and pathologic findings of two women who developed localized cutaneous argyria. We also review the characteristics of other patients with localized cutaneous argyria and summarize the differential diagnosis and treatment options for this condition.Materials and methodsThe features of two women with localized cutaneous argyria are presented. Using PubMed, the following terms were searched and relevant citations assessed: acquired localized argyria, acupuncture, argyria, argyrosis, colloidal silver, cutaneous argyria, and localized cutaneous argyria. In addition, the literature on localized cutaneous argyria is reviewed.ResultsTwo women presented with small, asymptomatic blue-gray macules appearing at sites directly adjacent to ear piercings. A punch biopsy was performed on one woman. Microscopic examination revealed a yellowish-brown colored granular material found adjacent to elastic fibers. Based on correlation of the clinical presentation and histopathologic findings, a diagnosis of localized cutaneous argyria was established. The second woman did not undergo a biopsy. However, the clinical presentation was highly suggestive of localized cutaneous argyria. Both women were reassured of the benign nature of the condition and agreed to return for clinical follow-up if they observed any changes in the appearance of the lesions.
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Wilson JD, Shann SM, Brady SK, Mammen-Tobin AG, Evans AL, Lee RA. Recurrent bacterial vaginosis: the use of maintenance acidic vaginal gel following treatment. Int J STD AIDS 2016; 16:736-8. [PMID: 16303068 DOI: 10.1258/095646205774763081] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Bacterial vaginosis (BV) frequently recurs after treatment. One option in the management of recurrences is to keep the vaginal pH at 4.5 or less, in order to prevent overgrowth of bacteria, until the normal lactobacilli are re-established. We report the outcome of using maintenance acetic acid vaginal gel, after treatment of BV, in a sample of 49 women with frequent recurrences. Half of the women had no further recurrences, and in those who did there was a significant increase in time to first recurrence (4.8 months) after commencing the gel compared with the previous recurrence (2.1 months). Prior to using acidic gel, the mean recurrence rate in 49 women was 4.4 per woman/year, and this was reduced to 0.6 recurrences per woman/year. As there are few effective therapies for women with recurrent BV, we feel this offers an option that can currently be used in clinical practice.
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Affiliation(s)
- J D Wilson
- Department of Genitourinary Medicine, The General Infirmary at Leeds, Great George Street, Leeds LS1 3EX, UK. janet_d.wilson.nhs.uk
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Abstract
Given the absence of significant improvement in the treatment of hidradenitis suppurativa (HS) with traditional medical and surgical therapies, biologics have piqued the interest of research investigators. The efficacy of biologics in the treatment of inflammatory conditions like psoriasis and rheumatoid arthritis is well-documented. More recently, success with biologics has been demonstrated in atopic dermatitis, another dermatological condition associated with inflammatory states. Researchers have begun to probe the utility of biologic agents in less prevalent conditions that feature inflammation as a key characteristic, namely, hidradenitis suppurativa. Five agents in particular adalimumab, anakinra, etanercept, infliximab, and ustekinumab, have been explored in the setting of HS. Results to date put forward adalimumab and infliximab as biologic treatments that can safely be initiated with some expectant efficacy. Other biologic agents require more rigorous examination before they are worthy of addition to the treatment armamentarium.
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Affiliation(s)
- Robert A Lee
- Dermatology Clinic, University of California San Diego, San Diego, California.
| | - Daniel B Eisen
- Department of Dermatology, University of California Davis, Sacramento, California
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Abstract
Prurigo pigmentosa, also referred to as Nagashima's disease, is a rare inflammatory skin condition of unknown etiology. It typically presents as pruritic erythematous papules, papulovesicles, and vesicles appearing in a reticular pattern on the back, chest, or neck. The histological features of prurigo pigmentosa vary according to the stage of the disease. Early-stage disease is characterized by a superficial perivascular infiltrate of neutrophils; spongiosis and necrotic keratinocytes commonly appear in later stages. The etiology of prurigo pigmentosa has yet to be determined. Oral minocycline is usually the first-line therapy for prurigo pigmentosa. However, doxycycline, macrolide antibiotics, and/or dapsone (diaminodiphenyl sulfone) may be indicated for some patients. We describe the key features of prurigo pigmentosa, including the epidemiology, clinical and histologic presentation, differential diagnosis, postulated pathogenesis, and treatment options for this condition.
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Affiliation(s)
- Bryce D Beutler
- University of Nevada School of Medicine, 1060 Wiegand Road, Encinitas, CA, 92024, USA.
| | - Philip R Cohen
- Department of Dermatology, University of California San Diego, San Diego, CA, USA.
| | - Robert A Lee
- Department of Dermatology, University of California San Diego, San Diego, CA, USA.
- Dermatopathology, University of California San Diego, San Diego, CA, USA.
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Zakeri K, Oganesyan G, Lee RA, Lillis JV. Erythema induratum of Bazin presenting as peripheral neuropathy. Cutis 2015; 96:E1-E4. [PMID: 26562274] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
Erythema induratum of Bazin (EIB) is a rare tuberculid that typically affects middle-aged women. We report a unique case of EIB in a 57-year-old Hispanic woman who presented with recurrent painful plaques and nodules on the lower extremities, specifically on the pretibial area of the legs and dorsal aspect of the feet, with a severe burning sensation on the feet that resolved after antituberculosis therapy. We review the characteristics of EIB and examine how the unique presentation of peripheral neuropathy may relate to the pathophysiology of this disease.
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Affiliation(s)
- Kaveh Zakeri
- 3855 Health Sciences Dr #0843, La Jolla, CA 92093-0843, USA.
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Lee RA, Ray M, Kasuga DT, Kumar V, Witherspoon CD, Baddley JW. Ocular bartonellosis in transplant recipients: two case reports and review of the literature. Transpl Infect Dis 2015; 17:723-7. [PMID: 26146758 DOI: 10.1111/tid.12418] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2014] [Revised: 04/20/2015] [Accepted: 06/28/2015] [Indexed: 11/27/2022]
Abstract
Cat scratch disease is caused by Bartonella henselae and usually manifests as localized lymphadenopathy and fever in immunocompetent patients. Immunocompromised patients are at risk for developing disseminated disease affecting the liver, spleen, eyes, central nervous system, and other organs. Bartonellosis is infrequently reported in solid organ transplant recipients, and published case reports usually discuss disseminated infection. Localized ocular disease with B. henselae, while well documented in immunocompetent hosts, is uncommon in immunocompromised patients. Herein, we present 2 cases of ocular bartonellosis in renal transplant patients, 1 with disseminated infection, and 1 without.
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Affiliation(s)
- R A Lee
- Division of Infectious Diseases, Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - M Ray
- Division of Infectious Diseases, Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - D T Kasuga
- Department of Ophthalmology, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - V Kumar
- Division of Nephrology, Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - C D Witherspoon
- Department of Ophthalmology, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - J W Baddley
- Division of Infectious Diseases, Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, USA.,Birmingham Veterans Affairs Medical Center, Birmingham, Alabama, USA
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Singh Ospina N, Thompson GB, Lee RA, Reading CC, Young WF. Safety and efficacy of percutaneous parathyroid ethanol ablation in patients with recurrent primary hyperparathyroidism and multiple endocrine neoplasia type 1. J Clin Endocrinol Metab 2015; 100:E87-90. [PMID: 25337928 DOI: 10.1210/jc.2014-3255] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/13/2023]
Abstract
CONTEXT The most common feature of multiple endocrine neoplasia type 1 (MEN1) is primary hyperparathyroidism (PHP), which occurs in approximately 95% of MEN1 patients. Approximately 40-60% of patients with MEN1 develop recurrent hypercalcemia within 10-12 years after their initial parathyroid surgery and the successful management of recurrent PHP is challenging. OBJECTIVE This study sought to evaluate the safety and efficacy of percutaneous ethanol ablation (PEA) for the treatment of recurrent PHP in patients with MEN1. DESIGN, SETTING, PATIENTS, INTERVENTION, OUTCOME MEASURED: We performed an electronic search to identify patients with a billing code for MEN1 who were seen at Mayo Clinic between 1977 and 2013. Patients with recurrent PHP who underwent PEA were identified and their clinical information was collected. We performed t test analyses to compare mean values. RESULTS Thirty-seven patients underwent 80 PEA treatments that included 123 sessions of ethanol administration. Twenty-one patients were women (56.8%) and the mean age at diagnosis of PHP was 33.8 years. The mean preprocedure calcium level was 10.7 mg/dl ± 0.57 (SD) and the mean postprocedure calcium level was 9.6 mg/dl ± 0.76 (P < .01). In 14 treatments (18.9%) the postprocedure calcium was greater than 10.1 mg/dl. Postprocedure hypocalcemia occurred in six treatments (8.1%). Normocalcemia was achieved in 54 of the treatment episodes (73%) and the mean duration of normocalcemia was 24.8 months. PEA was safe with transient hoarseness occurring in four of the treatments (5%). CONCLUSION The treatment of recurrent PHP in patients with MEN1 represents a challenge that is associated with increased morbidity. PEA is an effective treatment option for achieving normocalcemia in the majority of the patients with MEN1. PEA is associated with low rates of hypocalcemia and no permanent complications.
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Affiliation(s)
- Naykky Singh Ospina
- Division of Endocrinology, Diabetes, Metabolism, and Nutrition, and Department of Internal Medicine (N.S.O., W.F.Y.), Division of Endocrine Surgery and Department of Surgery (G.B.T.), and Department of Radiology (R.A.L., C.C.R.), Mayo Clinic, Rochester Minnesota 55905
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Cohen PR, Paravar T, Lee RA. Epidermal multinucleated giant cells are not always a histopathologic clue to a herpes virus infection: multinucleated epithelial giant cells in the epidermis of lesional skin biopsies from patients with acantholytic dermatoses can histologically mimic a herpes virus infection. Dermatol Pract Concept 2014; 4:21-7. [PMID: 25396080 PMCID: PMC4230253 DOI: 10.5826/dpc.0404a03] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2014] [Accepted: 07/24/2014] [Indexed: 11/02/2022] Open
Abstract
BACKGROUND Multinucleated giant cells in the epidermis can either be epithelial or histiocytic. Epithelial multinucleated giant cells are most often associated with herpes virus infections. PURPOSE To review the histologic differential diagnosis of conditions with epithelial and histiocytic multinucleated giant cells-since multinucleated giant cells in the epidermis are not always pathognomonic of a cutaneous herpes virus infection-and to summarize dermatoses in which herpes virus infection has been observed to coexist. METHODS Two individuals with acantholytic dermatoses whose initial lesional skin biopsies showed multinucleated epithelial giant cells suggestive of a herpes virus infection are reported. Using the PubMed database, an extensive literature search was performed on multinucleated giant cell (and epidermis, epithelial, and histiocytic) and herpes virus infection. Relevant papers were reviewed to discover the skin conditions with either multinucleated giant cells in the epidermis or coincident cutaneous herpes virus infection. RESULTS Initial skin biopsies from patients with either pemphigus vulgaris or transient acantholytic dermatosis mimicked herpes virus infection; however, laboratory studies and repeat biopsies established the correct diagnosis of their acantholytic dermatosis. Hence, epidermal multinucleated giant cells are not always a histopathologic clue to a herpes virus infection. Indeed, epithelial multinucleated giant cells in the epidermis can be observed not only in the presence of infection (herpes virus), but also acantholytic dermatoses and tumors (trichoepithelioma and pleomorphic basal cell carcinoma). Histiocytic multinucleated giant cells in the epidermis can be observed in patients with either giant cell lichenoid dermatitis or lichen nitidus of the palms. CONCLUSIONS Epithelial and histiocytic multinucleated giant cell can occur in the epidermis. Keratinocyte-derived multinucleated giant cells are most commonly associated with herpes virus infection; yet, they can also be observed in patients with skin tumors or acantholytic dermatoses. Cutaneous herpes simplex virus infection can coexist in association with other conditions such as acantholytic dermatoses, benign skin tumors, bullous disorders, hematologic malignancies, inflammatory dermatoses, and physical therapies. However, when a herpes virus infection is suspected based upon the discovery of epithelial multinucleated giant cells in the epidermis, but either the clinic presentation or lack of response to viral therapy or absence of confirmatory laboratory studies does not support the diagnosis of a viral infection, the possibility of a primary acantholytic dermatosis should be considered and additional lesional skin biopsies performed. Also, because hematoxylin and eosin staining is not the golden standard for confirmation of autoimmune bullous dermatoses, skin biopsies for direct immunofluorescence should be performed when a primary bullous dermatosis is suspected since the histopathology observed on hematoxylin and eosin stained sections can be misleading.
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Affiliation(s)
- Philip R Cohen
- Division of Dermatology, University of California San Diego, San Diego, California
| | - Taraneh Paravar
- Division of Dermatology, University of California San Diego, San Diego, California
| | - Robert A Lee
- Division of Dermatology, University of California San Diego, San Diego, California
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Azfar RS, Lee RA, Castelo-Soccio L, Greenberg MS, Bilker WB, Gelfand JM, Kovarik CL. Reliability and validity of mobile teledermatology in human immunodeficiency virus-positive patients in Botswana: a pilot study. JAMA Dermatol 2014; 150:601-7. [PMID: 24622778 DOI: 10.1001/jamadermatol.2013.7321] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
IMPORTANCE Mobile teledermatology may increase access to care. OBJECTIVE To determine whether mobile teledermatology in human immunodeficiency virus (HIV)-positive patients in Gaborone, Botswana, was reliable and produced valid assessments compared with face-to-face dermatologic consultations. DESIGN, SETTING, AND PARTICIPANTS Cross-sectional study conducted in outpatient clinics and public inpatient settings in Botswana for 76 HIV-positive patients 18 years and older with a skin or mucosal condition that had not been evaluated by a dermatologist. MAIN OUTCOMES AND MEASURES We calculated the κ coefficient for diagnosis, diagnostic category, and management for test-retest and interrater reliability. We also determined sensitivity and specificity for each diagnosis. RESULTS The κ coefficient for test-retest reliability ranged from 0.47 (95% CI, 0.35 to 0.59) to 0.78 (0.67 to 0.88) for the primary diagnosis, 0.29 (0.18 to 0.42) to 0.73 (0.61 to 0.84) for diagnostic category, and 0.17 (-0.01 to 0.36) to 0.54 (0.38 to 0.70) for management. The κ coefficient for interrater reliability ranged from 0.41 (95% CI, 0.31 to 0.52) to 0.51 (0.41 to 0.61) for the primary diagnosis, 0.22 (0.14 to 0.31) to 0.43 (0.34 to 0.53) for diagnostic category, and 0.08 (0.02 to 0.15) to 0.12 (0.01 to 0.23) for management. Sensitivity and specificity for the top 10 diagnoses varied from 0 to 0.88 and 0.84 to 1.00, respectively. CONCLUSIONS AND RELEVANCE Our results suggest that while the use of mobile teledermatology technology in HIV-positive patients in Botswana has significant potential for improving access to care, additional work is needed to improve the reliability and validity of this technology on a larger scale in this population.
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Affiliation(s)
- Rahat S Azfar
- Department of Dermatology, University of Pennsylvania, Philadelphia2Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania, Philadelphia
| | - Robert A Lee
- Division of Dermatology, Department of Medicine, University of California-San Diego, San Diego
| | | | - Martin S Greenberg
- Department of Oral Medicine, University of Pennsylvania School of Dental Medicine, Philadelphia
| | - Warren B Bilker
- Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania, Philadelphia
| | - Joel M Gelfand
- Department of Dermatology, University of Pennsylvania, Philadelphia2Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania, Philadelphia
| | - Carrie L Kovarik
- Department of Dermatology, University of Pennsylvania, Philadelphia
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Lee RA, Van Zundert AAJ, Visser WA, Lataster LMA, Wieringa PA. Thoracic Combined Spinal-Epidural (CSE) Anaesthesia. Southern African Journal of Anaesthesia and Analgesia 2014. [DOI: 10.1080/22201173.2008.10872524] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Goldenberg A, Lee RA, Cohen PR. Acantholytic dyskeratotic acanthoma: case report and review of the literature. Dermatol Pract Concept 2014; 4:25-30. [PMID: 25126453 PMCID: PMC4131993 DOI: 10.5826/dpc.0403a03] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2014] [Accepted: 03/19/2014] [Indexed: 10/31/2022] Open
Abstract
BACKGROUND Focal acantholytic dyskeratosis has been described as an incidental finding and as a clinically distinct lesion. In both situations, a dimorphic histologic pattern is observed: acantholysis and dyskeratosis. Solitary, non-genital lesions displaying such pathology have been difficult to classify. Clinical and pathological characteristics of acantholytic dyskeratotic acanthomas are described. METHODS The features of a patient with solitary, non-genital, acantholytic dyskeratotic acanthoma are presented and the literature on acantholytic dyskeratotic acanthomas is reviewed. Using PubMed the following terms were searched and relevant citations assessed: acantholysis, acanthoma, cutaneous, dyskeratosis, nail, warty. RESULTS We identified 30 cutaneous acantholytic dyskeratotic acanthomas, including our patient, most often found on the trunk and mimicking basal cell carcinoma, and three subungual acantholytic dyskeratotic acanthomas of the thumb, which mimicked onychopapilloma. CONCLUSION Acantholytic dyskeratotic acanthomas are clinically and pathologically distinct lesions, which may morphologically present as either truncal plaques or subungual longitudinal erythronychia.
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Affiliation(s)
- Alina Goldenberg
- Medical School, University of California San Diego, California, USA
| | - Robert A Lee
- Division of Dermatology, University of California San Diego, California, USA ; Dermatopathology, University of California San Diego, California, USA
| | - Philip R Cohen
- Division of Dermatology, University of California San Diego, California, USA
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Wu W, Li C, Lee RA, Hata T. The use of sirolimus to treat Kaposi's sarcoma in an HIV-negative rheumatoid arthritis patient on disease-modifying drug therapies. Int J Dermatol 2014; 54:1188-90. [DOI: 10.1111/ijd.12234] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2012] [Revised: 12/21/2012] [Accepted: 02/15/2013] [Indexed: 11/29/2022]
Affiliation(s)
- Wiggin Wu
- Department of Dermatology; University of California San Diego; San Diego CA USA
| | - Chao Li
- Department of Dermatology; University of California San Diego; San Diego CA USA
| | - Robert A. Lee
- Department of Dermatology; University of California San Diego; San Diego CA USA
| | - Tissa Hata
- Department of Dermatology; University of California San Diego; San Diego CA USA
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Affiliation(s)
- Cuong V. Nguyen
- University of California, San Diego; School of Medicine; San Diego CA USA
| | - Adriane M. Boyle
- Department of Dermatology; University of California; San Diego CA USA
| | - Robert A. Lee
- Department of Dermatology; University of California; San Diego CA USA
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Cohen PR, Lee RA. Adult-onset reticulohistiocytoma presenting as a solitary asymptomatic red knee nodule: report and review of clinical presentations and immunohistochemistry staining features of reticulohistiocytosis. Dermatol Online J 2014; 20:doj_21725. [PMID: 24656263] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2014] [Accepted: 03/14/2014] [Indexed: 06/03/2023] Open
Abstract
Reticulohistiocytomas are benign dermal tumors that usually present as either solitary or multiple, cutaneous nodules. Reticulohistiocytosis can present as solitary or generalized skin tumors or cutaneous lesions with systemic involvement and are potentially associated with internal malignancy. A woman with a solitary red nodule on her knee is described in whom the clinical differential diagnosis included dermatofibroma and amelanotic malignant melanoma. Hematoxylin and eosin staining and immunoperoxidase studies of the biopsy specimen established the diagnosis of adult-onset reticulohistiocytoma (solitary epithelioid histiocytoma). Reticulohistiocytoma is characterized by mononuclear, and occasionally multinuclear, histiocytes with eosinophilic "glassy" cytoplasm. The immunohistochemical profile of a reticulohistiocytoma demonstrates consistent positive expression for CD68 (a marker that is expressed by histiocytes but can also show positive staining in melanomas and carcinomas), CD163 (a very specific marker for histiocytes), and vimentin. Reticulohistiocytomas show variable positive expression for MITF (microphthalmia transcription factor) and S100 protein, both of which are more commonly used as markers for melanocytes. Recurrence of a reticulohistiocytoma is rare, even for patients with an incompletely removed lesion. However, our patient elected to have her residual tumor completely excised.
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MESH Headings
- Adult
- Antigens, CD/analysis
- Antigens, Differentiation, Myelomonocytic/analysis
- Biomarkers/analysis
- Biopsy
- Diagnosis, Differential
- Female
- Histiocytes/chemistry
- Histiocytoma, Benign Fibrous/diagnosis
- Histiocytosis, Non-Langerhans-Cell/diagnosis
- Histiocytosis, Non-Langerhans-Cell/metabolism
- Histiocytosis, Non-Langerhans-Cell/pathology
- Humans
- Immunoenzyme Techniques
- Knee/pathology
- Melanocytes/chemistry
- Melanoma, Amelanotic/diagnosis
- Microphthalmia-Associated Transcription Factor/analysis
- Receptors, Cell Surface/analysis
- S100 Proteins/analysis
- Skin Neoplasms/diagnosis
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Affiliation(s)
- Philip R Cohen
- Division of Dermatology, University of California San Diego, San Diego, California.
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Cohen PR, Lee RA. Adult-onset reticulohistiocytoma presenting as a solitary asymptomatic red knee nodule: report and review of clinical presentations and immunohistochemistry staining features of reticulohistiocytosis. Dermatol Online J 2014. [DOI: 10.5070/d3203021725] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
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Hay ID, Lee RA, Davidge-Pitts C, Reading CC, Charboneau JW. Long-term outcome of ultrasound-guided percutaneous ethanol ablation of selected “recurrent” neck nodal metastases in 25 patients with TNM stages III or IVA papillary thyroid carcinoma previously treated by surgery and 131I therapy. Surgery 2013; 154:1448-54; discussion 1454-5. [DOI: 10.1016/j.surg.2013.07.007] [Citation(s) in RCA: 89] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2013] [Accepted: 07/03/2013] [Indexed: 11/17/2022]
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Lee RA. We all need to be a part of shaping our future. Iowa Med 2013; 103:6. [PMID: 25219181] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
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Lee RA. Iowa has a strong statewide medical society supporting our profession. Iowa Med 2013; 103:6. [PMID: 25211980] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
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Lee RA. Each of us has a role to play in building a better future. Iowa Med 2012; 102:6. [PMID: 23437559] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
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Lee RA. To expand Medicaid or not to expand: that is the question. Iowa Med 2012; 102:4. [PMID: 23472521] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
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Afshar M, Lee RA, Jiang SIB. Desmoplastic trichilemmoma--a report of successful treatment with Mohs micrographic surgery and a review and update of the literature. Dermatol Surg 2012; 38:1867-71. [PMID: 22805188 DOI: 10.1111/j.1524-4725.2012.02514.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- Maryam Afshar
- Division of Dermatology, Department of Medicine, University of California at San Diego, CA, USA
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Nguyen BT, Lortscher DN, Lee RA. Multiple poromas in a bone marrow transplant recipient: A case report. Dermatol Online J 2012; 18:9. [PMID: 22863631] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/01/2023] Open
Abstract
A poroma is a benign epithelial neoplasm that most commonly presents as a solitary papule on the palm or sole. We report the case of a 25-year-old male, with a history of acute myelogenous leukemia, who developed multiple poromas on the feet. Poromatosis - the occurrence of multiple poromas - has been described in six adults and one child; it appears to be more prevalent in patients with a history of lymphoproliferative disorder or radiation exposure.
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Affiliation(s)
- Bichchau T Nguyen
- Department of Medicine (Dermatology), University of California, San Diego, San Diego, California, USA
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Lee RA. Organized medicine's role in helping our profession respond to change. Iowa Med 2012; 102:4-5. [PMID: 23061241] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
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Lee RA. Let's work together and embrace the change that's best for our patients. Iowa Med 2012; 102:6. [PMID: 22860364] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
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Tran HT, Lee RA, Oganesyan G, Jiang SB. Single treatment of non-melanoma skin cancers using a pulsed-dye laser with stacked pulses. Lasers Surg Med 2012; 44:459-67. [DOI: 10.1002/lsm.22032] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/29/2012] [Indexed: 11/11/2022]
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Melancon JM, Tom WL, Lee RA, Jackson M, Brian Jiang SI. Management of Pilomatrix Carcinoma: A Case Report of Successful Treatment with Mohs Micrographic Surgery and Review of the Literature. Dermatol Surg 2011; 37:1798-805. [DOI: 10.1111/j.1524-4725.2011.02170.x] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Cannella AP, Nguyen BM, Piggott CD, Lee RA, Vinetz JM, Mehta SR. A cluster of cutaneous leishmaniasis associated with human smuggling. Am J Trop Med Hyg 2011; 84:847-50. [PMID: 21633017 DOI: 10.4269/ajtmh.2011.10-0693] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
Cutaneous leishmaniasis (CL) is rarely seen in the United States, and the social and geographic context of the infection can be a key to its diagnosis and management. Four Somali and one Ethiopian, in U.S. Border Patrol custody, came to the United States by the same human trafficking route: Djibouti to Dubai to Moscow to Havana to Quito; and then by ground by Columbia/Panama to the United States-Mexico border where they were detained. Although traveling at different times, all five patients simultaneously presented to our institution with chronic ulcerative skin lesions at different sites and stages of evolution. Culture of biopsy specimens grew Leishmania panamensis. Soon thereafter, three individuals from East Africa traveling the identical route presented with L. panamensis CL to physicians in Tacoma, WA. We document here the association of a human trafficking route and new world CL. Clinicians and public health officials should be aware of this emerging infectious disease risk.
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Affiliation(s)
- Anthony P Cannella
- Division of Infectious Diseases and Division of Dermatology, Department of Medicine, University of California-San Diego, La Jolla, CA 92093, USA
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