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Ghonimi T, Hamad A, Fouda T, AlAli F, Ezzat M, Awad M, Ibrahim R, Amin M, Alkadi M, Al-Malki HA. Cardiovascular calcification in hemodialysis patients: A Qatar-based prevalence and risk factors study. Qatar Med J 2024; 2024:18. [PMID: 38654817 PMCID: PMC11037094 DOI: 10.5339/qmj.2024.18] [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: 11/05/2023] [Accepted: 02/25/2024] [Indexed: 04/26/2024] Open
Abstract
BACKGROUND Patients with end-stage kidney disease on hemodialysis (HD) have an increased risk of death due to the high prevalence of cardiovascular disease. Vascular calcification (VC) is predictive of cardiovascular disease and mortality. We conducted a study to evaluate the prevalence and risk factors for VC in dialysis patients in Qatar. METHODS This is a retrospective nationwide study including all chronic ambulatory dialysis patients in Qatar from 2020 to 2022. We used our national electronic medical record to track demographics, clinical characteristics, comorbidities, laboratory values, and diagnostic data for each patient. Calcifications were assessed by echocardiography (routinely done for all our dialysis population per national protocol), computed tomography, X-ray, and ultrasound. The study protocol was approved by the local medical research ethics committee (MRC-01-20-377). RESULTS 842 HD patients were included in this study. Vascular calcifications (VC) were prevalent in 52.6% of patients. The main site of VC was Mitral valve calcifications in 55.5% of patients. Patients with VC were significantly older and had more prevalence of diabetes mellitus (p = 0.001 and p = 0.006, respectively). There was no statistically significant difference between patients with calcifications and patients without calcifications regarding serum calcium, phosphorus, and PTH level. In multivariate analysis, age and diabetes significantly increased the risk factor for calcification (95% CI 1.033-1.065, p < 0.0001, and 95% CI 1.128-2.272, p < 0001, respectively). Moreover, higher vitamin D levels and higher doses of IV Alfacalcidol were significant risk factors for calcifications (95% CI 1.005-1.030, p < 0.007, and 95% CI 1.092-1.270, p < 0.0001, respectively). CONCLUSION Our study found that vascular calcification was widespread among our dialysis population in Qatar. Implementing the practice of echocardiography in dialysis patients was extremely helpful and the most productive in detecting vascular calcification. Diabetes mellitus almost doubles the risk for vascular calcifications in dialysis patients. These results are beneficial in identifying risk factors for vascular calcification, which can help stratify dialysis patients' risk of cardiovascular disease and optimize prevention efforts.
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Affiliation(s)
- Tarek Ghonimi
- Division of Nephrology, Department of Medicine, Hamad Medical Corporation, Doha, Qatar
| | - Abdullah Hamad
- Division of Nephrology, Department of Medicine, Hamad Medical Corporation, Doha, Qatar
| | - Tarek Fouda
- Division of Nephrology, Department of Medicine, Hamad Medical Corporation, Doha, Qatar
| | - Fadwa AlAli
- Division of Nephrology, Department of Medicine, Hamad Medical Corporation, Doha, Qatar
| | - Mohamad Ezzat
- Division of Nephrology, Department of Medicine, Hamad Medical Corporation, Doha, Qatar
| | - Mohamed Awad
- Division of Nephrology, Department of Medicine, Hamad Medical Corporation, Doha, Qatar
| | - Rania Ibrahim
- Division of Nephrology, Department of Medicine, Hamad Medical Corporation, Doha, Qatar
| | - Mohamed Amin
- Division of Nephrology, Department of Medicine, Hamad Medical Corporation, Doha, Qatar
| | - Mohamad Alkadi
- Division of Nephrology, Department of Medicine, Hamad Medical Corporation, Doha, Qatar
| | - Hassan Ali Al-Malki
- Division of Nephrology, Department of Medicine, Hamad Medical Corporation, Doha, Qatar
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Sacks M, Tjiattas‐Saleski L. A 70-year-old female with knee pain after a fall. J Am Coll Emerg Physicians Open 2024; 5:e13088. [PMID: 38186554 PMCID: PMC10766507 DOI: 10.1002/emp2.13088] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2023] [Accepted: 11/28/2023] [Indexed: 01/09/2024] Open
Affiliation(s)
- Madison Sacks
- Department of Clinical AffairsEdward Via College of Osteopathic MedicineSpartanburgSouth CarolinaUSA
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Cao K, Gao F, Long R, Zhang FD, Huang CC, Cao M, Yu YZ, Sun YS. Peri-lesion regions in differentiating suspicious breast calcification-only lesions specifically on contrast enhanced mammography. J Xray Sci Technol 2024:XST230332. [PMID: 38306089 DOI: 10.3233/xst-230332] [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] [Subscribe] [Scholar Register] [Indexed: 02/03/2024]
Abstract
PURPOSE The explore the added value of peri-calcification regions on contrast-enhanced mammography (CEM) in the differential diagnosis of breast lesions presenting as only calcification on routine mammogram. METHODS Patients who underwent CEM because of suspicious calcification-only lesions were included. The test set included patients between March 2017 and March 2019, while the validation set was collected between April 2019 and October 2019. The calcifications were automatically detected and grouped by a machine learning-based computer-aided system. In addition to extracting radiomic features on both low-energy (LE) and recombined (RC) images from the calcification areas, the peri-calcification regions, which is generated by extending the annotation margin radially with gradients from 1 mm to 9 mm, were attempted. Machine learning (ML) models were built to classify calcifications into malignant and benign groups. The diagnostic matrices were also evaluated by combing ML models with subjective reading. RESULTS Models for LE (significant features: wavelet-LLL_glcm_Imc2_MLO; wavelet-HLL_firstorder_Entropy_MLO; wavelet-LHH_glcm_DifferenceVariance_CC; wavelet-HLL_glcm_SumEntropy_MLO;wavelet-HLH_glrlm_ShortRunLowGray LevelEmphasis_MLO; original_firstorder_Entropy_MLO; original_shape_Elongation_MLO) and RC (significant features: wavelet-HLH_glszm_GrayLevelNonUniformityNormalized_MLO; wavelet-LLH_firstorder_10Percentile_CC; original_firstorder_Maximum_MLO; wavelet-HHH_glcm_Autocorrelation_MLO; original_shape_Elongation_MLO; wavelet-LHL_glszm_GrayLevelNonUniformityNormalized_MLO; wavelet-LLH_firstorder_RootMeanSquared_MLO) images were set up with 7 features. Areas under the curve (AUCs) of RC models are significantly better than those of LE models with compact and expanded boundary (RC v.s. LE, compact: 0.81 v.s. 0.73, p < 0.05; expanded: 0.89 v.s. 0.81, p < 0.05) and RC models with 3 mm boundary extension yielded the best performance compared to those with other sizes (AUC = 0.89). Combining with radiologists' reading, the 3mm-boundary RC model achieved a sensitivity of 0.871 and negative predictive value of 0.937 with similar accuracy of 0.843 in predicting malignancy. CONCLUSIONS The machine learning model integrating intra- and peri-calcification regions on CEM has the potential to aid radiologists' performance in predicting malignancy of suspicious breast calcifications.
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Affiliation(s)
- Kun Cao
- Department of Radiology, Peking University Cancer Hospital & Institute, Key laboratory of Carcinogenesis and Translational Research (Ministry of Education), Beijing, China
| | - Fei Gao
- AI Lab, Deepwise & League of PhD Technology Co. LTD, Beijing, China
| | - Rong Long
- Department of Radiology, Peking University Cancer Hospital & Institute, Key laboratory of Carcinogenesis and Translational Research (Ministry of Education), Beijing, China
| | - Fan-Dong Zhang
- AI Lab, Deepwise & League of PhD Technology Co. LTD, Beijing, China
| | - Chen-Cui Huang
- AI Lab, Deepwise & League of PhD Technology Co. LTD, Beijing, China
| | - Min Cao
- Department of Radiology, Peking University Cancer Hospital & Institute, Key laboratory of Carcinogenesis and Translational Research (Ministry of Education), Beijing, China
| | - Yi-Zhou Yu
- AI Lab, Deepwise & League of PhD Technology Co. LTD, Beijing, China
| | - Ying-Shi Sun
- Department of Radiology, Peking University Cancer Hospital & Institute, Key laboratory of Carcinogenesis and Translational Research (Ministry of Education), Beijing, China
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Nguyen A, Mirchandani A, Joseph S, Mapkar Z, Singh E. Digital Breast Tomosynthesis With Synthetic Mammography: Are We Missing Calcifications That Matter? J Breast Imaging 2023; 5:666-674. [PMID: 38141240 DOI: 10.1093/jbi/wbad073] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2022] [Indexed: 12/25/2023]
Abstract
OBJECTIVE To determine whether there are differences in the biopsy outcomes for suspicious calcifications detected with screening mammography using the digital breast tomosynthesis and synthetic 2D (DBT/SM) technique compared to calcifications detected using the full-field digital (DM) technique. METHODS This retrospective study was IRB approved. The records for all stereotactic biopsies performed for suspicious calcifications detected on screening mammograms using DM in 2011-2014 and DBT/SM in 2017-2020 were reviewed. We collected patient, imaging, and pathology data from the breast imaging database and from retrospective review of a subset of mammograms. The biopsy outcome results were categorized as benign, benign with upgrade potential (BWUP), and malignant based on final pathology. Frequencies and proportions of outcomes were calculated and compared using Mann-Whitney U tests and Wilcoxson signed-rank tests with P-values and 95% confidence intervals (95% CIs). RESULTS From 2011 to 2014 (DM), 1274 stereotactic biopsies of calcifications yielded 74.2% (945/1274) benign, 11.5% (147/1274) BWUP, and 14.3% (182/1274) malignant outcomes. From 2017 to 2020 (DBT/SM), 1049 stereotactic biopsies yielded 65.2% (684/1049) benign, 15.6% (164/1049) BWUP, and 19.2% (201/1049) malignant outcomes. With DBT/SM, benign biopsy outcomes decreased (9.0%, 95% CI 0.87-11.53, P < 0.05), whereas malignant biopsy outcomes increased (4.9%, 95% CI 0.94-8.36, P < 0.05). There was no significant difference in BWUP biopsy outcomes and total biopsy rates between techniques (P > 0.05). CONCLUSION Calcifications detected with screening DBT/SM technique were significantly more likely to be malignant than those found using DM. These results support using the DBT/SM technique without obtaining concurrent DM images.
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Affiliation(s)
- Adrien Nguyen
- Ascension Providence Southfield Hospital/Michigan State University College of Human Medicine, Department of Radiology, Southfield, MI, USA
| | - Anicia Mirchandani
- Ascension Providence Southfield Hospital/Michigan State University College of Human Medicine, Department of Radiology, Southfield, MI, USA
| | - Sumita Joseph
- Ascension Providence Southfield Hospital/Michigan State University College of Human Medicine, Department of Radiology, Southfield, MI, USA
| | - Zaiba Mapkar
- Ascension Providence Southfield Hospital/Michigan State University College of Human Medicine, Department of Radiology, Southfield, MI, USA
| | - Evita Singh
- Ascension Providence Southfield Hospital/Michigan State University College of Human Medicine, Department of Radiology, Southfield, MI, USA
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Alsaleh N. Chondroid lipoma that may mimic malignancy: A case report. Clin Case Rep 2023; 11:e8059. [PMID: 37867545 PMCID: PMC10587652 DOI: 10.1002/ccr3.8059] [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] [Subscribe] [Scholar Register] [Received: 06/10/2023] [Revised: 08/08/2023] [Accepted: 10/04/2023] [Indexed: 10/24/2023] Open
Abstract
Chondroid lipoma is rare benign lipomatous lesion could mimic other soft tissue tumor.
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Affiliation(s)
- Nuha Alsaleh
- Department of SurgeryCollege of Medicine, King Saud UniversityRiyadhSaudi Arabia
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Scaffei E, Buchignani B, Pasquariello R, Cristofani P, Canapicchi R, Biagi L, Giordano F, De Marco E, Crow YJ, Battini R. Case report: Clinical and neuroradiological longitudinal follow-up in Leukoencephalopathy with Calcifications and Cysts during treatment with bevacizumab. Front Neurol 2023; 14:1245014. [PMID: 37799282 PMCID: PMC10548379 DOI: 10.3389/fneur.2023.1245014] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2023] [Accepted: 08/30/2023] [Indexed: 10/07/2023] Open
Abstract
Leukoencephalopathy with Calcifications and Cysts (LCC) is a rare genetic microangiopathy exclusively affecting the central nervous system caused by biallelic mutations in SNORD118. Brain magnetic resonance imaging (MRI) is often diagnostic due to the highly characteristic triad of leukoencephalopathy, intracranial calcifications, and brain cysts. Age at onset, presentation and disease evolution can all vary, ranging from pauci-symptomatic disease to rapid evolution of signs with loss of motor and cognitive abilities. No specific therapies for LCC are currently licensed. According to the literature, bevacizumab might represent an effective modality to improve the clinical and MRI features of the disease. However, uncertainty remains as to the true efficacy of this approach, when to begin therapy, appropriate dosing, and the consequences of drug withdrawal. According to CARE guidelines, we describe the long-term clinical and neuro-radiological follow-up of a 10-year-old child with LCC. We report disease evolution following repeated cycles of treatment with bevacizumab. Our case report suggests that repeated cycles of bevacizumab might effectively modify disease progression, possibly indicating a time-dependent effect.
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Affiliation(s)
- Elena Scaffei
- Department of Neuroscience, IRCCS Stella Maris Foundation, Pisa, Italy
- Department of Neuroscience, Psychology, Drug Research and Child Health NEUROFARBA, University of Florence, Florence, Italy
| | - Bianca Buchignani
- Department of Neuroscience, IRCCS Stella Maris Foundation, Pisa, Italy
| | - Rosa Pasquariello
- Department of Neuroscience, IRCCS Stella Maris Foundation, Pisa, Italy
| | - Paola Cristofani
- Department of Neuroscience, IRCCS Stella Maris Foundation, Pisa, Italy
| | | | - Laura Biagi
- Department of Neuroscience, IRCCS Stella Maris Foundation, Pisa, Italy
| | - Flavio Giordano
- Department of Neuroscience, Psychology, Drug Research and Child Health NEUROFARBA, University of Florence, Florence, Italy
- Department of Neurosurgery, Meyer Children's Hospital IRCCS, Florence, Italy
| | - Emanuela De Marco
- Paediatric Oncology and Haematology Department, Santa Chiara Hospital, Azienda Ospedaliero Universitaria Pisana, Pisa, Italy
| | - Yanick J. Crow
- MRC Human Genetics Unit, Institute of Genetics and Cancer, University of Edinburgh, Edinburgh, United Kingdom
- Laboratory of Neurogenetics and Neuroinflammation, Institut Imagine, Paris Descartes University, Paris, France
| | - Roberta Battini
- Department of Neuroscience, IRCCS Stella Maris Foundation, Pisa, Italy
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
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Făgărășan A, Gurzu S, Satala CB, Hagău AC. The Importance of Aortic Valve Bicuspid Phenotype in Valvular Evolution in Pediatric Patients: A Case Report and Literature Mini-Review. Int J Mol Sci 2023; 24:14027. [PMID: 37762329 PMCID: PMC10531046 DOI: 10.3390/ijms241814027] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2023] [Revised: 09/09/2023] [Accepted: 09/11/2023] [Indexed: 09/29/2023] Open
Abstract
Bicuspid aortic valve (BAV) is the most commonly encountered congenital malformation in the pediatric population, associated with aortic leaflet degeneration and aortopathy. However, studies on BAV and its complications in children are limited. We present the case of a 16-year-old with type 1B BAV with a raphe with fusion between the right and non-coronary cusps who exhibited severe aortic stenosis, regurgitation, and progressive dilatation of the ascending aorta. Surgical intervention, including aortic valve and aortic root replacement, was performed due to the patient's deteriorating condition. Histopathological examination revealed degenerative changes and calcifications in the aortic valve and mucoid fibrosis in the ascending aorta. The results are consistent with BAV patients being predisposed to aortic stenosis and regurgitation due to increased mechanical stress and hemodynamic abnormalities. Although more common in adults and a rare complication in pediatric patients, calcification was previously observed concurrently with rapid valve degeneration in our daily practice. Further studies are needed to improve our understanding of the mechanisms underlying BAV-related complications and refine treatment strategies for pediatric patients.
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Affiliation(s)
- Amalia Făgărășan
- Department of Pediatrics III, Faculty of Medicine, George Emil Palade University of Medicine, Pharmacy, Science and Technology of Targu Mures, 540136 Targu Mures, Romania
- Department of Pediatric Cardiology, Emergency Institute for Cardiovascular Diseases and Transplantation of Târgu Mureș, 540136 Targu Mures, Romania
| | - Simona Gurzu
- Department of Pathology, Clinical County Emergency Hospital, 540136 Targu Mures, Romania
- Department of Pathology, George Emil Palade University of Medicine, Pharmacy, Science and Technology of Targu Mures, 540142 Targu Mures, Romania
| | - Catalin-Bogdan Satala
- Department of Pathology, Clinical County Emergency Hospital, 540136 Targu Mures, Romania
- Department of Pathology, George Emil Palade University of Medicine, Pharmacy, Science and Technology of Targu Mures, 540142 Targu Mures, Romania
| | - Asmaa Carla Hagău
- Department of Pediatric Cardiology, Emergency Institute for Cardiovascular Diseases and Transplantation of Târgu Mureș, 540136 Targu Mures, Romania
- Doctoral School of Medicine and Pharmacy, I.O.S.U.D., George Emil Palade University of Medicine, Pharmacy, Science and Technology of Targu Mures, 540136 Targu Mures, Romania
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Batesh D, Habash R, Alhaffar MN, Almani I. Pulmonary alveolar microlithiasis: a rare case report from Syria. Ann Med Surg (Lond) 2023; 85:4566-4569. [PMID: 37663718 PMCID: PMC10473359 DOI: 10.1097/ms9.0000000000001060] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2023] [Accepted: 07/01/2023] [Indexed: 09/05/2023] Open
Abstract
Introduction and importance This report presents a case of pulmonary alveolar microlithiasis (PAM), a rare disease characterized by dry cough, dyspnea, and chest pain. Most reported cases are from Turkey, with a frequency of 1.85 in 1 million, and there are no documented cases from Syria in the medical literature. Here, we present the first case report from Syria. Case presentation A 56-year-old male patient complained of a dry cough that began 4 years ago and had worsened over the last 3 months, along with a grade I dyspnea. Chest radiograph showed a 'sandstorm-like' appearance, and a computed tomography scan revealed diffuse ground-glass opacities. To confirm the diagnosis, we performed a transbronchial lung biopsy and bronchial washing. Histopathology results revealed interalveolar calcification consistent with PAM. The diagnosis was based on radiological and lung biopsy findings. The patient received oxygen therapy, resulting in significant improvement. We recommended the use of a home oxygen machine for episodes of shortness of breath. Clinical discussion PAM is an autosomal recessive disease caused by a mutation in the SLC34A2 gene (solute carrier family 34, member 2 gene), characterized by intra-alveolar airspace microliths called calcospherites. Miliary tuberculosis should be considered a differential diagnosis. Conclusions The disease progresses slowly and is often diagnosed incidentally. Lung transplantation remains the only effective treatment.
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Affiliation(s)
| | | | - Mhd Nabih Alhaffar
- Department of Pulmonary Medicine, Damascus University, Al-Mouwasat University Hospital, Damascus, Syria
| | - Imad Almani
- Department of Pulmonary Medicine, Damascus University, Al-Mouwasat University Hospital, Damascus, Syria
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G VL, Ahamed AS, Rajeswari MRC, Karthick P, Jayasenthil A. Cemento-Ossifying Fibroid Epulis in the Posterior Maxilla. Cureus 2023; 15:e46167. [PMID: 37905253 PMCID: PMC10613318 DOI: 10.7759/cureus.46167] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/28/2023] [Indexed: 11/02/2023] Open
Abstract
Cemento-ossifying fibroma is a benign fibro-osseous lesion arising from the periodontal ligament and has the potential to form cementum and bone in the periodontal ligament. Cemento-ossifying fibroma is a painless, pedunculated, or sessile, smooth exophytic growth arising attached to the gingival tissues. We present a case of cemento-ossifying fibroid epulis in the posterior maxilla attached to the interdental gingiva between the 26 and 27 region buccally in a 52-year-old female patient managed with surgical excision of the lesion, extraction of the involved teeth, curettage, and palatal obturator while under general anesthesia. The patient was followed up post-operatively, healing was satisfactory, there were no signs of infection, and no recurrence was noted in the six-month follow-up period.
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Affiliation(s)
- Vijaya Lakshmi G
- Department of Oral and Maxillofacial Surgery, Priyadarshini Dental College and Hospital, Chennai, IND
| | - A Saneem Ahamed
- Department of Oral and Maxillofacial Surgery, Priyadarshini Dental College and Hospital, Chennai, IND
| | - M R C Rajeswari
- Department of Oral Pathology and Microbiology, Priyadarshini Dental College and Hospital, Chennai, IND
| | - Prem Karthick
- Department of Oral Pathology and Microbiology, Priyadarshini Dental College and Hospital, Chennai, IND
| | - A Jayasenthil
- Department of Conservative Dentistry and Endodontics, Priyadarshini Dental College and Hospital, Chennai, IND
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Scarparo P, Schermers T, Improta R, Kardys I, Wilschut J, Daemen J, Nuis RJ, Den Dekker WK, Van Mieghem NM, Diletti R. Stent expansion in calcified coronary chronic total occlusions: The impact of different stent platforms. Catheter Cardiovasc Interv 2023; 102:451-463. [PMID: 37526236 DOI: 10.1002/ccd.30774] [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] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2023] [Revised: 06/23/2023] [Accepted: 07/09/2023] [Indexed: 08/02/2023]
Abstract
OBJECTIVES To evaluate the stent expansion of the durable-polymer Zotarolimus-eluting stent (dp-ZES), the durable-polymer Everolimus-eluting stent (dp-EES), and the bioabsorbable-polymer Sirolimus-eluting stent (bp-SES) in calcified coronary chronic total occlusions (CTO). BACKGROUND The newer generation stents with ultrathin struts might raise concerns regarding reduced radial strength and higher stent recoil (SR) when implanted in calcified CTOs. METHODS Between January 2017 and June 2021 consecutive patients with CTO undergoing percutaneous coronary intervention with dp-ZES, dp-EES, or bp-SES were evaluated. The analysis was performed in calcific and in noncalcific CTOs. Quantitative coronary angiography analysis was used to assess diameter stenosis (DS), absolute and relative SR, absolute and relative focal SR, absolute and relative balloon deficit (BD), and absolute and relative focal BD. The primary endpoint was DS. RESULTS A total of 213 CTOs were evaluated, 115 calcific CTOs (dp-ZES:25, dp-EES:29, bp-SES:61) and 98 non-calcific CTOs (dp-ZES:41, dp-EES:11, bp-SES:46). In calcific CTOs, residual DS was lower in dp-ZES than in dp-EES and bp-SES (-1.00% [-6.50-6.50] vs. 13.00% [7.0-19.00] vs. 15.00% [5.00-20.00]; p < 0.001). Dp-ZES was also an independent predictor of residual DS ≤ 10% (OR 11.34, 95% CI 2.6-49.43, p = 0.001). Absolute and relative focal SR and absolute and relative SR were similar between dp-ZES, dp-EES, and bp-SES (p = 0.913, p = 0.890, p = 0.518, p = 0.426, respectively). In noncalcified CTOs, the residual DS was similar in the three groups (p = 0.340). High relative focal SR was less frequent in dp-ZES than in dp-EES and in bp-SES (19.5% vs. 54.5% vs. 37.0%; p < 0.048). CONCLUSIONS The three stent platforms demonstrated an overall low residual DS when implanted in CTOs. However, dp-ZES was associated with the lowest residual DS and identified as independent predictor of residual DS ≤ 10% in patients with calcific CTOs. Dp-ZES was associated with a lower incidence of high relative focal stent recoil, in noncalcific CTOs. Balloon deficit might be considerate as a surrogate for stent expansion in calcified CTOs.
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Affiliation(s)
- Paola Scarparo
- Department of Interventional Cardiology, Thoraxcenter, Erasmus University Medical Centre, Rotterdam, The Netherlands
| | - Thom Schermers
- Department of Interventional Cardiology, Thoraxcenter, Erasmus University Medical Centre, Rotterdam, The Netherlands
| | - Riccardo Improta
- Department of Interventional Cardiology, Thoraxcenter, Erasmus University Medical Centre, Rotterdam, The Netherlands
| | - Isabella Kardys
- Department of Interventional Cardiology, Thoraxcenter, Erasmus University Medical Centre, Rotterdam, The Netherlands
| | - Jeroen Wilschut
- Department of Interventional Cardiology, Thoraxcenter, Erasmus University Medical Centre, Rotterdam, The Netherlands
| | - Joost Daemen
- Department of Interventional Cardiology, Thoraxcenter, Erasmus University Medical Centre, Rotterdam, The Netherlands
| | - Rutger-Jan Nuis
- Department of Interventional Cardiology, Thoraxcenter, Erasmus University Medical Centre, Rotterdam, The Netherlands
| | - Wijnand K Den Dekker
- Department of Interventional Cardiology, Thoraxcenter, Erasmus University Medical Centre, Rotterdam, The Netherlands
| | - Nicolas M Van Mieghem
- Department of Interventional Cardiology, Thoraxcenter, Erasmus University Medical Centre, Rotterdam, The Netherlands
| | - Roberto Diletti
- Department of Interventional Cardiology, Thoraxcenter, Erasmus University Medical Centre, Rotterdam, The Netherlands
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Boutaybi M, Aloutmani B, El-Azrak M, Ismaili N, El Ouafi N. Acute coronary syndromes in chronic hemodialysis patients: a series of 34 cases (case series). Ann Med Surg (Lond) 2023; 85:3791-3796. [PMID: 37554882 PMCID: PMC10406026 DOI: 10.1097/ms9.0000000000000941] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2023] [Accepted: 05/31/2023] [Indexed: 08/10/2023] Open
Abstract
UNLABELLED Cardiovascular diseases, particularly acute coronary syndrome, are the leading cause of death in chronic hemodialysis patients. Our study aims to analyze the pathophysiological, clinical, angiographic, and therapeutic characteristics of coronary heart disease in hemodialysis patients. PATIENTS AND METHODS This single-centered retrospective descriptive study included 34 hemodialysis patients hospitalized in the cardiovascular ICU. RESULTS The mean age of patients in our study was 64.4±11.3 years. The main cardiovascular risk factor found in our study was age, with a prevalence of 76.50%, followed by hypertension, with a prevalence of 67.60%. Diabetes was present in 55.90% of patients. The authors also found that 17.90% of patients were obese, and 29.40% had abdominal obesity. The main cause of renal disease in our study was diabetic nephropathy (52.90% of cases), followed by hypertensive nephropathy (23.50% of cases). ST segment elevation myocardial infarction was found in 14.70% of cases, and non-ST-segment elevation myocardial infarction in 85.30% of cases. Coronary angiography was performed in 76.40% of patients. Single-vessel coronary artery disease (CAD) was found in 20%, two-vessel CAD in 50%, and three-vessel CAD in 30% of the cases. Coronary artery calcifications were observed in 21.42% of cases. 38.23% had an angioplasty, and 20.58% were referred for a coronary artery bypass graft. CONCLUSION Despite the high mortality rate after acute coronary syndrome, hemodialysis patients are less likely to undergo diagnostic angiography or coronary revascularization. Patients on hemodialysis tend to have multiple, diffuse, calcified CAD.
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Affiliation(s)
| | | | | | - Nabila Ismaili
- Department of Cardiology, Mohammed VI University Hospital
- Epidemiological Laboratory of Clinical Research and Public Health, Faculty of Medicine and Pharmacy of Oujda, Mohammed First University, Oujda, Morocco
| | - Noha El Ouafi
- Department of Cardiology, Mohammed VI University Hospital
- Epidemiological Laboratory of Clinical Research and Public Health, Faculty of Medicine and Pharmacy of Oujda, Mohammed First University, Oujda, Morocco
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12
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Gleue C, Bois M, Guo R. Calciphylaxis in autopsy: A retrospective case-controlled study of 7 decedents. JAAD Case Rep 2023; 35:60-62. [PMID: 37078015 PMCID: PMC10106467 DOI: 10.1016/j.jdcr.2023.02.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/21/2023] Open
Affiliation(s)
- Casey Gleue
- Division of Anatomic and Clinical Pathology, Mayo Clinic, Rochester, Minnesota
| | - Melanie Bois
- Division of Anatomic and Clinical Pathology, Mayo Clinic, Rochester, Minnesota
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota
| | - Ruifeng Guo
- Division of Anatomic and Clinical Pathology, Mayo Clinic, Rochester, Minnesota
- Correspondence to: Ruifeng Guo, MD, PhD, Hilton Building, Mayo Clinic Department of Anatomic and Clinical Pathology, 210 2nd St SW, Rochester, MN 55905.
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13
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Naim T, Khan D, Ali M, Fanciullo J. Crowned Dens Syndrome: A Challenging Diagnosis in Older Adults Presenting With Acute Neck Pain. Cureus 2023; 15:e37101. [PMID: 37153310 PMCID: PMC10158671 DOI: 10.7759/cureus.37101] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/03/2023] [Indexed: 05/09/2023] Open
Abstract
Crowned dens syndrome (CDS) is a rare syndrome of calcium pyrophosphate dihydrate (CPPD) deposition on the odontoid process of the second cervical vertebra leading to unique clinical presentation and radiographical findings. Symptoms usually overlap with more common etiologies, including meningitis, stroke, and giant cell arteritis. Thus, patients struggle with extensive evaluation before diagnosing this uncommon condition. There are few case reports and case series of CDS in the literature. Patients respond well to treatment, but unfortunately, there is a high rate of relapse. Here we present an interesting case of a 78-year-old female patient who presented with acute onset headache and neck pain.
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Affiliation(s)
- Touba Naim
- Internal Medicine, Avera McKennan Hospital and University Health Center, Sioux Falls, USA
| | - Dawlat Khan
- Internal Medicine, University of South Dakota Sanford School of Medicine, Sioux Falls, USA
| | - Mohammad Ali
- Internal Medicine, University of South Dakota Sanford School of Medicine, Sioux Falls, USA
| | - Joseph Fanciullo
- Internal Medicine, University of South Dakota Sanford School of Medicine, Sioux Falls, USA
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14
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Galante AS, Tollefson LJ. Splenic calcifications in a patient with Systemic Lupus Erythematosus: an imaging case review. J Can Chiropr Assoc 2023; 67:97-100. [PMID: 37250459 PMCID: PMC10211401] [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: 05/31/2023]
Abstract
A 47-year-old female presented to a chiropractic clinic with known diagnosis of systemic lupus erythematosus. Radiographic examination demonstrated multiple splenic calcifications, an uncommon, yet important finding. The patient was subsequently referred to her primary care physician for co-management and further evaluation.
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15
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Badki SD, Lohe V, Bhowate R, Kadu RP, Sune R, Wanjari MB. Conventional Radiology in Deep Seated Facial Hemangioma: A Case Report. Cureus 2023; 15:e35186. [PMID: 36960270 PMCID: PMC10030065 DOI: 10.7759/cureus.35186] [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: 01/19/2023] [Accepted: 02/18/2023] [Indexed: 02/21/2023] Open
Abstract
Hemangioma is congenital or traumatic in origin, and it is caused due to atypical build-up of the blood vessel. It is a painless benign condition with typical characteristic clinical features. These generally occur in the first three decades of life with no gender predispositions. A plain soft tissue radiograph can demonstrate phleboliths and aid in diagnosing an intramuscular hemangioma. The present report is a rare deep-seated facial hemangioma involving various facial muscles with multiple phleboliths; characteristics clinical and radiological features. A 22-year-old male patient reported a complaint of swelling on the right side of the jaw. Conventional radiography showed the right cheek's soft tissue and multiple round, target-like radiopacities of variable sizes.
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Affiliation(s)
- Simran D Badki
- Department of Oral Medicine and Radiology, Sharad Pawar Dental College and Hospital, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Vidya Lohe
- Department of Oral Medicine and Radiology, Sharad Pawar Dental College and Hospital, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Rahul Bhowate
- Department of Oral Medicine and Radiology, Sharad Pawar Dental College and Hospital, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Ravindra P Kadu
- Department of Pathology, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Ravikant Sune
- Department of Oral Medicine and Radiology, Sharad Pawar Dental College and Hospital, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Mayur B Wanjari
- Department of Research and Development, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
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16
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Nguyen DL, Boron A, Oluyemi ET, Myers KS, Mullen LA, Ambinder EB. Comparison of Diagnostic Mammography-Guided Biopsy and Digital Breast Tomosynthesis-Guided Biopsy of Suspicious Breast Calcifications: Results in 1354 Biopsies. AJR Am J Roentgenol 2023; 220:212-23. [PMID: 36102725 DOI: 10.2214/AJR.22.28320] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
BACKGROUND. Studies have shown improved targeting and sampling of noncalcified lesions (asymmetries, masses, and architectural distortion) with digital breast tomosynthesis (DBT)-guided biopsy in comparison with digital mammography (DM)-guided stereotactic biopsy. Literature that compares the two techniques specifically for sampling calcifications has been scarce. OBJECTIVE. The purpose of this study was to compare the performance and outcomes of DM- and DBT-guided biopsy of suspicious calcifications. METHODS. This retrospective study included 1310 patients (mean age, 58 ± 12 [SD] years) who underwent a total of 1354 9-gauge vacuum-assisted core biopsies of suspicious calcifications performed at a single institution from May 22, 2017, to December 31, 2021. The decision to use a DM-guided or DBT-guided technique was made at the discretion of the radiologist performing the biopsy. Procedure time, the number of exposures during the procedure, and the histopathologic outcomes were recorded. The two techniques were compared using a two-sample t test for continuous variables and a chi-square test for categoric variables. Additional tests were performed using generalized estimating equations to control for the effect of the individual radiologist performing the biopsy. RESULTS. A total of 348 (26%) biopsies used DM guidance, and 1006 (74%) used DBT guidance. The mean procedure time was significantly lower for DBT-guided biopsy (14.9 ± 8.0 [SD] minutes) than for DM-guided biopsy (24.7 ± 14.3 minutes) (p < .001). The mean number of exposures was significantly lower for DBT-guided biopsy (4.1 ± 1.0 [SD] exposures) than for DM-guided biopsy (9.1 ± 3.3 exposures) (p < .001). The differences in procedure time and number of exposures remained significant (both p < .001) when controlling for the effect of the radiologist performing the biopsy. There were no significant differences (all p > .05) between DM-guided and DBT-guided biopsy in terms of the malignancy rate on initial biopsy (20% vs 19%), the rate of high-risk lesion upgrading (14% vs 22%), or the final malignancy rate (23% vs 22%). CONCLUSION. DBT-guided biopsy of suspicious calcifications can be performed with shorter procedure time and fewer exposures compared with DM-guided biopsy, without a significant difference in rates of malignancy or high-risk lesion upgrading. CLINICAL IMPACT. The use of a DBT-guided, rather than a DM-guided, biopsy technique for suspicious calcifications can potentially reduce patient discomfort and radiation exposure without affecting clinical outcomes.
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17
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Affiliation(s)
- Aurela Clark
- University of Kentucky, Department of Radiology, Lexington, KY, USA
| | - Johnrick Bishop
- University of Kentucky, Department of Radiology, Lexington, KY, USA
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18
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Amabile N, Bressollette E, Souteyrand G, Landolff Q, Veugeois A, Honton B. [Invasive and non-invasive imaging analysis for calcified coronary artery lesions]. Ann Cardiol Angeiol (Paris) 2022; 71:372-380. [PMID: 36220707 DOI: 10.1016/j.ancard.2022.09.003] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2022] [Accepted: 09/17/2022] [Indexed: 06/16/2023]
Abstract
Coronary calcifications are frequently identified within coronary lesions as their incidence increases with age and cardiovascular risk factors. Their location can be superficial or deep, according to different pathological process. In all cases, the presence of calcifications within the vascular wall predicts poor clinical prognosis and unfavorable evolution after percutaneous revascularization. Coronary calcifications can be analyzed by angiography, CT or intracoronary imaging (IVUS or OCT) with variable accuracies. Angiography is the most frequently used method but is not very sensitive (sensitivity close to 50%) and insufficient for their precise quantification. The CT scan is a more effective non-invasive method leading to an accurate analysis of the lesion before coronary angiography. IVUS and OCT have an excellent spatial resolution and are the most sensitive methods for the identification (present in nearly 75-80% of lesions) and quantification of calcifications. These intracoronary imaging techniques offer interesting perspectives for identification of the highest-risk lesions, PCI procedures planning (including the choice of an optimal dedicated plaque preparation devices), the monitoring of their execution and the evaluation of the immediate post-stenting results.
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Affiliation(s)
- Nicolas Amabile
- Service de Cardiologie, Institut Mutualiste Montsouris, Paris, France.
| | | | - Géraud Souteyrand
- Service de Cardiologie, CHU Gabriel Montpied, Clermont Ferrand, France
| | | | - Aurèlie Veugeois
- Service de Cardiologie, Institut Mutualiste Montsouris, Paris, France
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19
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Abstract
When interpreting mammography, breast radiologists may identify radiopaque densities in the axilla on the mediolateral oblique or lateral projections. When such densities are encountered, true calcifications must be differentiated from pseudocalcifications (artifact). Using imaging, breast radiologists should be able to localize the finding as being dermal, within the soft tissues, within a lymph node, or intramuscular. By combining the anatomic location with the clinical presentation and any other imaging findings, breast radiologists will be able to determine the most appropriate management.
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Affiliation(s)
- Aayushi Rai
- Massachusetts General Hospital, Department of Radiology, Boston, MA, USA
| | - Michael D C Fishman
- Boston University Medical Center, Department of Radiology, Boston, MA and Boston University School of Medicine, Boston, MA, USA
| | - Anna F Rives
- Boston University Medical Center, Department of Radiology, Boston, MA and Boston University School of Medicine, Boston, MA, USA
| | - Priscilla J Slanetz
- Boston University Medical Center, Department of Radiology, Boston, MA and Boston University School of Medicine, Boston, MA, USA
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20
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Azanjac A, Petrovic M, Vesic K. Incidental diagnosis of Fahr's syndrome after coronavirus disease 2019 infection with the fatal outcome. Hippokratia 2022; 26:161. [PMID: 37497533 PMCID: PMC10367947] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/28/2023]
Affiliation(s)
- Arsic Azanjac
- Department of Neurology, Faculty of Medical Sciences, University of Kragujevac, Kragujevac, Serbia
- Clinic of Neurology, University Clinical Centre, Kragujevac, Serbia
| | - M Petrovic
- Clinic of Neurology, University Clinical Centre, Kragujevac, Serbia
| | - K Vesic
- Department of Neurology, Faculty of Medical Sciences, University of Kragujevac, Kragujevac, Serbia
- Clinic of Neurology, University Clinical Centre, Kragujevac, Serbia
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21
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Witt JK, Warden AC, Dodd MD, Edney EE. Visual bias could impede diagnostic accuracy of breast cancer calcifications. J Med Imaging (Bellingham) 2022; 9:035503. [PMID: 35692281 DOI: 10.1117/1.jmi.9.3.035503] [Citation(s) in RCA: 1] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2021] [Accepted: 05/12/2022] [Indexed: 01/07/2023] Open
Abstract
Purpose: Diagnosing breast cancer based on the distribution of calcifications is a visual task and thus prone to visual biases. We tested whether a recently discovered visual bias that has implications for breast cancer diagnosis would be present in expert radiologists, thereby validating the concern of this bias for accurate diagnoses. Approach: We ran a vision experiment with expert radiologists and untrained observers to test the presence of visual bias when judging the spread of dots that resembled calcifications and when judging the spread of line orientations. We calculated visual bias scores for both groups for both tasks. Results: Participants overestimated the spread of the dots and the spread of the line orientations. This bias, referred to as the variability overestimation effect, was of similar magnitudes in both expert radiologists and untrained observers. Even though the radiologists were better at both tasks, they were similarly biased compared with the untrained observers. Conclusions: The results justify the concern of the variability overestimation effect for accurate diagnoses based on breast calcifications. Specifically, the bias is likely to lead to an increased number of false-negative results, thereby leading to delayed treatments.
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Affiliation(s)
- Jessica K Witt
- Colorado State University, Department of Psychology, Fort Collins, Colorado, United States
| | - Amelia C Warden
- Colorado State University, Department of Psychology, Fort Collins, Colorado, United States
| | - Michael D Dodd
- University of Nebraska-Lincoln, Department of Psychology, Lincoln, Nebraska, United States
| | - Elizabeth E Edney
- University of Nebraska Medical Center, Omaha, Nebraska, United States
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22
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Rduch T, Tsolaki E, El Baz Y, Leschka S, Born D, Kinkel J, Anthis AHC, Fischer T, Jochum W, Hornung R, Gogos A, Herrmann IK. The Role of Inorganics in Preeclampsia Assessed by Multiscale Multimodal Characterization of Placentae. Front Med (Lausanne) 2022; 9:857529. [PMID: 35433726 PMCID: PMC9009444 DOI: 10.3389/fmed.2022.857529] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2022] [Accepted: 03/07/2022] [Indexed: 12/03/2022] Open
Abstract
Preeclampsia is one of the most dangerous diseases in pregnancy. Because of the hypertensive nature of preeclampsia, placental calcifications are believed to be a predictor for its occurrence, analogous to their role in cardiovascular diseases. However, the prevalence and the relevance of calcifications for the clinical outcome with respect to preeclampsia remains controversial. In addition, the role of other inorganic components present in the placental tissue in the development of preeclampsia has rarely been investigated. In this work, we therefore characterized inorganic constituents in placental tissue in groups of both normotensive and preeclamptic patients (N = 20 each) using a multi-scale and multi-modal approach. Examinations included elemental analysis (metallomics), sonography, computed tomography (CT), histology, scanning electron microscopy, X-ray fluorescence and energy dispersive X-ray spectroscopy. Our data show that tissue contents of several heavy metals (Al, Cd, Ni, Co, Mn, Pb, and As) were elevated whereas the Rb content was decreased in preeclamptic compared to normotensive placentae. However, the median mineral content (Ca, P, Mg, Na, K) was remarkably comparable between the two groups and CT showed lower calcified volumes and fewer crystalline deposits in preeclamptic placentae. Electron microscopy investigations revealed four distinct types of calcifications, all predominantly composed of calcium, phosphorus and oxygen with variable contents of magnesium in tissues of both maternal and fetal origin in both preeclamptic and normotensive placentae. In conclusion our study suggests that heavy metals, combined with other factors, can be associated with the development of preeclampsia, however, with no obvious correlation between calcifications and preeclampsia.
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Affiliation(s)
- Thomas Rduch
- Laboratory for Particles Biology Interactions, Swiss Federal Laboratories for Materials Science and Technology (Empa), St. Gallen, Switzerland.,Department of Gynaecology and Obstetrics, Kantonsspital St.Gallen, St. Gallen, Switzerland
| | - Elena Tsolaki
- Laboratory for Particles Biology Interactions, Swiss Federal Laboratories for Materials Science and Technology (Empa), St. Gallen, Switzerland.,Nanoparticle Systems Engineering Laboratory, Department of Mechanical and Process Engineering, Institute of Process Engineering, ETH Zürich, Zurich, Switzerland
| | - Yassir El Baz
- Department of Radiology, Kantonsspital St.Gallen, St. Gallen, Switzerland
| | - Sebastian Leschka
- Department of Radiology, Kantonsspital St.Gallen, St. Gallen, Switzerland
| | - Diana Born
- Institute of Pathology, Kantonsspital St.Gallen, St. Gallen, Switzerland
| | - Janis Kinkel
- Department of Gynaecology and Obstetrics, Kantonsspital St.Gallen, St. Gallen, Switzerland
| | - Alexandre H C Anthis
- Laboratory for Particles Biology Interactions, Swiss Federal Laboratories for Materials Science and Technology (Empa), St. Gallen, Switzerland.,Nanoparticle Systems Engineering Laboratory, Department of Mechanical and Process Engineering, Institute of Process Engineering, ETH Zürich, Zurich, Switzerland
| | - Tina Fischer
- Department of Gynaecology and Obstetrics, Kantonsspital St.Gallen, St. Gallen, Switzerland
| | - Wolfram Jochum
- Institute of Pathology, Kantonsspital St.Gallen, St. Gallen, Switzerland
| | - René Hornung
- Department of Gynaecology and Obstetrics, Kantonsspital St.Gallen, St. Gallen, Switzerland
| | - Alexander Gogos
- Laboratory for Particles Biology Interactions, Swiss Federal Laboratories for Materials Science and Technology (Empa), St. Gallen, Switzerland.,Nanoparticle Systems Engineering Laboratory, Department of Mechanical and Process Engineering, Institute of Process Engineering, ETH Zürich, Zurich, Switzerland
| | - Inge K Herrmann
- Laboratory for Particles Biology Interactions, Swiss Federal Laboratories for Materials Science and Technology (Empa), St. Gallen, Switzerland.,Nanoparticle Systems Engineering Laboratory, Department of Mechanical and Process Engineering, Institute of Process Engineering, ETH Zürich, Zurich, Switzerland
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23
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Janeiro J, Barreira SC, Martins P, Ninitas P, Campos J, Fonseca JE. Ultrasound Features Associated With Shoulder Complaints: Calcifications Larger Than 6 mm in Young Patients and Positive Doppler Are Associated With Pain. Front Med (Lausanne) 2021; 8:715423. [PMID: 34869414 PMCID: PMC8639518 DOI: 10.3389/fmed.2021.715423] [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] [Subscribe] [Scholar Register] [Received: 05/26/2021] [Accepted: 10/28/2021] [Indexed: 11/13/2022] Open
Abstract
Objectives: To identify ultrasound (US) features associated with the presence of shoulder complaints. Methods: This observational, case-control study, compared US findings between participants with and without shoulder complaints, matched for age, sex, and dominancy. Data was collected from February 2018 to June 2020. Two-tailed Fisher's and Mann-Whitney U-tests were used, with p-values < 0.05 considered significant. Results: A total of 202 participants were enrolled (median age 56 years, range 18–70, 155 women), comprising 140 cases and 62 controls. A calcification size ≥6 mm, when age < 56 (p = 0.02), and a distance to tendon insertion ≥6 mm, when age ≥56 (p = 0.009), were only found in symptomatic shoulders. Color Doppler in rotator cuff (RC) tendons predominated in the presence of symptoms (26/140 vs. 2/62, p = 0.003). An algorithm also combining the number of calcifications, tendon echotexture and insertional thickening, osseous irregularity, cuff tears, and subacromial effusion showed a 92% (57/62) specificity for shoulder pain on this study sample. Conclusion: Calcification diameter of 6 mm or more is associated with shoulder pain in patients younger than 56 years. A distance from calcification to tendon insertion of 6 mm or more is related to pain in older patients. Doppler signal also is associated with shoulder pain. An algorithm based on a set of specific ultrasonographic criteria have a strong association with the presence of symptoms.
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Affiliation(s)
- João Janeiro
- Serviço de Imagiologia Geral, Hospital de Santa Maria, Centro Hospitalar Universitário Lisboa Norte, Centro Académico de Medicina de Lisboa, Lisboa, Portugal
| | - Sofia C Barreira
- Serviço de Reumatologia e Doenças Ósseas Metabólicas, Hospital de Santa Maria Centro Hospitalar Universitário Lisboa Norte, Lisboa, Portugal.,Unidade de Investigação em Reumatologia, Instituto de Medicina Molecular, Faculdade de Medicina, Universidade de Lisboa, Centro Académico de Medicina de Lisboa, Lisboa, Portugal
| | - Patrícia Martins
- Serviço de Reumatologia e Doenças Ósseas Metabólicas, Hospital de Santa Maria Centro Hospitalar Universitário Lisboa Norte, Lisboa, Portugal.,Unidade de Investigação em Reumatologia, Instituto de Medicina Molecular, Faculdade de Medicina, Universidade de Lisboa, Centro Académico de Medicina de Lisboa, Lisboa, Portugal
| | - Pedro Ninitas
- Serviço de Imagiologia Geral, Hospital de Santa Maria, Centro Hospitalar Universitário Lisboa Norte, Centro Académico de Medicina de Lisboa, Lisboa, Portugal
| | - Jorge Campos
- Serviço de Imagiologia Neurológica, Hospital de Santa Maria, Centro Hospitalar Universitário Lisboa Norte, Centro Académico de Medicina de Lisboa, Lisboa, Portugal
| | - João E Fonseca
- Serviço de Reumatologia e Doenças Ósseas Metabólicas, Hospital de Santa Maria Centro Hospitalar Universitário Lisboa Norte, Lisboa, Portugal.,Unidade de Investigação em Reumatologia, Instituto de Medicina Molecular, Faculdade de Medicina, Universidade de Lisboa, Centro Académico de Medicina de Lisboa, Lisboa, Portugal
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24
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White AC. Calcifications and the Global Burden of Neurocysticercosis: Not Just Rocks in Your Head. Clin Infect Dis 2021; 73:e2604-e2606. [PMID: 32556094 DOI: 10.1093/cid/ciaa764] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2020] [Accepted: 06/11/2020] [Indexed: 11/14/2022] Open
Affiliation(s)
- A Clinton White
- Infectious Disease Division, Department of Internal Medicine, University of Texas Medical Branch, Galveston, Texas, USA
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25
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Psychogios K, Xiromerisiou G, Kargiotis O, Safouris A, Fiolaki A, Bonakis A, Paraskevas GP, Giannopoulos S, Tsivgoulis G. Hereditary cerebral amyloid angiopathy mimicking CADASIL syndrome. Eur J Neurol 2021; 28:3866-3869. [PMID: 34655264 DOI: 10.1111/ene.14981] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [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: 05/12/2021] [Revised: 06/10/2021] [Accepted: 06/12/2021] [Indexed: 11/26/2022]
Abstract
BACKGROUND Small vessel disease (SVD), and most specifically hereditary forms like CADASIL and cerebral amyloid angiopathy (hCAA), are conditions of increasing clinical importance. We report a rare case of hCAA in a Greek family that presented with a CADASIL clinical and neuroimaging phenotype. METHODS A 65-year-old man was admitted with recurrent transient episodes of right leg numbness. The patient's medical history started at the age of 50 years with depression and behavioral disorders. His family history was positive for stroke (father), dementia (father and brother), migraine (daughter) and depression (father and daughter). RESULTS Neurological examination disclosed anomic aphasia with severely impaired cognitive status, and brisk reflexes. Brain computed tomography and magnetic resonance imaging showed CADASIL-like leukoencephalopathy (hyperintense lesions in bilateral temporopolar area, external capsule, thalami, centrum semiovale and superior frontal regions) with occipital calcifications and cerebral microbleeds. Screen for variants in NOTCH3 gene was negative. Exome sequencing revealed a novel pathogenic mutation for hCAA. CONCLUSIONS We report a novel amyloid precursor protein mutation which results in a CADASIL-like clinical phenotype (progressive cognitive and motor decline, stroke, migraine and behavioral disorders) and CADASIL-leukoencephalopathy coupled with occipital calcifications. Earlier recognition and swift hCAA diagnosis may prompt rational preventive and potential disease-modifying interventions.
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Affiliation(s)
- Klearchos Psychogios
- Stroke Unit, Metropolitan Hospital, Piraeus, Greece.,Second Department of Neurology, School of Medicine, "Attikon" University Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Georgia Xiromerisiou
- Department of Neurology, Faculty of Medicine, School of Health Sciences, University Hospital of Larissa, University of Thessaly, Larissa, Greece
| | | | | | | | - Anastasios Bonakis
- Second Department of Neurology, School of Medicine, "Attikon" University Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Georgios P Paraskevas
- Second Department of Neurology, School of Medicine, "Attikon" University Hospital, National and Kapodistrian University of Athens, Athens, Greece.,Neurogenetics Unit, 1st Department of Neurology, Eginition University Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Sotirios Giannopoulos
- Second Department of Neurology, School of Medicine, "Attikon" University Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Georgios Tsivgoulis
- Second Department of Neurology, School of Medicine, "Attikon" University Hospital, National and Kapodistrian University of Athens, Athens, Greece.,Department of Neurology, The University of Tennessee Health Science Center, Memphis, TN, USA
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26
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Mendes Pinto C, Freixo J, Brandão AF, Magalhães M. Pons Calcifications and Striatal Necrosis in ADAR1 Aicardi-Goutières Syndrome. Mov Disord Clin Pract 2021; 8:1159-1161. [PMID: 34631961 DOI: 10.1002/mdc3.13320] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2021] [Revised: 07/16/2021] [Accepted: 07/26/2021] [Indexed: 11/06/2022] Open
Affiliation(s)
| | - João Freixo
- CGPP-Centro de Genética Preditiva e Preventiva, IBMC-Instituto de Biologia Molecular e Celular Porto Portugal.,i3S-Instituto de Investigação e Inovação em Saúde Universidade do Porto Porto Portugal
| | - Ana Filipa Brandão
- CGPP-Centro de Genética Preditiva e Preventiva, IBMC-Instituto de Biologia Molecular e Celular Porto Portugal.,i3S-Instituto de Investigação e Inovação em Saúde Universidade do Porto Porto Portugal
| | - Marina Magalhães
- Neurology Department Centro Hospitalar Universitário do Porto Porto Portugal
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Geusens D, van Malenstein H. The role of extracorporeal shock wave lithotripsy in the treatment of chronic pancreatitis. Acta Gastroenterol Belg 2021; 84:620-6. [PMID: 34965044 DOI: 10.51821/84.4.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Pain is the most frequent symptom in chronic pancreatitis (CP) and has an important impact on quality of life. One of its major pathophysiological mechanisms is ductal hypertension, caused by main pancreatic duct stones and/or strictures. In this article, we focus on extracorporeal shock wave lithotripsy (ESWL) as a treatment for main pancreatic duct stones, which have been reported in >50% of CP patients. ESWL uses acoustic pulses to generate compressive stress on the stones, resulting in their gradual fragmentation. In patients with radiopaque obstructive main pancreatic duct (MPD) stones larger than 5 mm, located in the pancreas head or body, ESWL improves ductal clearance, thereby relieving pain and improving quality of life. In case of insufficient ductal clearance or the presence of an MPD stricture, ESWL can be followed by endoscopic retrograde cholangiopancreatography (ERCP) to increase success rate. Alternatively, direct pancreaticoscopy with intracorporeal lithotripsy or surgery can be performed.
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Kobaly K, Kim CS, Langer JE, Mandel SJ. Macro calcifications Do Not Alter Malignancy Risk Within the American Thyroid Association Sonographic Pattern System When Present in Non-High Suspicion Thyroid Nodules. Thyroid 2021; 31:1542-1548. [PMID: 34314256 DOI: 10.1089/thy.2021.0140] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Background: The American Thyroid Association Sonographic Pattern System (ATASPS) depicts five levels of suspicion for malignancy based on the sonographic appearance of a thyroid nodule. However, 3-37% of nodules are non-classifiable when the combination of grayscale findings is not depicted by the ATASPS. The only calcifications included in the ATASPS are in solid hypoechoic high suspicion (HS) nodules and include both microcalcifications and peripheral interrupted calcifications with soft tissue extrusion. Non-hypoechoic nodules with these and other calcification patterns, which we defined as non-high suspicion calcifications (NHSC), are not classifiable by ATASPS. We assessed the effect of assigning an ATASPS risk level to nodules with NHSC based on analysis of their other grayscale features. Methods: A retrospective review of 728 consecutively biopsied nodules was performed. Nodules were classified by ATASPS as HS, intermediate suspicion (IS), low suspicion (LS), or very low suspicion (VLS); other nodules with patterns not described by ATASPS were non-classifiable (NC). If NC was due to NHSC, the nodule was assigned an ATASPS by analysis of grayscale features alone. Cytology and pathology results were correlated with assigned ATASPS level. Results: A NC pattern was observed in 144 of the 728 nodules (20%). Of these, 101/144 (70%) had NHSC and the assigned ATASPS was IS (n = 18), LS (n = 62) and VLS (n = 21). The distribution of cytology diagnoses within this group was similar to classifiable nodules (IS p = 0.13, LS p = 0.55, VLS p = 0.44). The majority of NHSC (n = 92, 91%) were macrocalcifications (large central or linear dystrophic calcifications); however, 9 LS pattern nodules had punctate echogenic foci, possibly representing microcalcifcations, with an estimated cancer prevalence of 19% (vs. 10% for total LS group, p = 0.24). The remaining NC nodules (43/144, 30%) included solid nodules with heterogeneous echogenicity (n = 30) or presence of a complete circumferential rim calcification, limiting further sonographic assessment (n = 13). Malignancy was identified in 11 out of 43 (26%) of these [9/30 (30%) heterogeneous solid and 2/13 (15%) with complete rim calcifications]. Conclusions: Macrocalcifications accounted for the majority of NHSC and these did not alter the expected ATASPS malignancy risk based on grayscale features.
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Affiliation(s)
- Kristen Kobaly
- Division of Endocrinology, Diabetes and Metabolism, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Caroline S Kim
- Division of Endocrinology, Diabetes and Metabolism, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Jill E Langer
- Department of Radiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Susan J Mandel
- Division of Endocrinology, Diabetes and Metabolism, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
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Fitzgerald J, Ziegler ME, Green PT, Neville BW. Calcified facial and maxillary arteries: Incidental radiographic findings indicative of Mönckeberg arteriosclerosis. J Am Dent Assoc 2021; 152:943-946. [PMID: 34373081 DOI: 10.1016/j.adaj.2021.04.018] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2020] [Revised: 10/22/2020] [Accepted: 04/26/2021] [Indexed: 11/19/2022]
Abstract
BACKGROUND AND OVERVIEW Mönckeberg arteriosclerosis is a disease of unknown etiology characterized by dystrophic calcifications within the tunica media of small- and medium-sized arteries, leading to reduced arterial compliance. The authors report a case discovered incidentally on dental radiographs. CASE DESCRIPTION A 78-year-old man with a complex medical history was seen for routine oral health care. Panoramic and bite-wing radiographs revealed a tortuous, linear calcification in the area of the left mandibular first molar anterior to the angle of the mandible and suggestive of a calcified facial artery. CONCLUSIONS AND PRACTICAL IMPLICATIONS Medical radiologists have used the presence of arterial calcifications to determine the severity and prognosis of such diseases as primary hyperparathyroidism, secondary hyperparathyroidism, coronary artery disease, and diabetes. The presence of Mönckeberg arteriosclerosis on dental radiographs can help oral health care professionals identify patients with undiagnosed systemic disease.
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Jin H, Ren X, Wu H, Hou Y, Fang F. Case Report: Clinical Features of Childhood Leukoencephalopathy With Cerebral Calcifications and Cysts Due to SNORD118 Variants. Front Neurol 2021; 12:585606. [PMID: 34220662 PMCID: PMC8248351 DOI: 10.3389/fneur.2021.585606] [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] [Subscribe] [Scholar Register] [Received: 07/21/2020] [Accepted: 05/11/2021] [Indexed: 11/29/2022] Open
Abstract
Background: Leukoencephalopathy with cerebral calcifications and cysts (LCC) is a rare autosomal recessive cerebral microangiopathy. Recently, biallelic variants in a non-protein-coding gene SNORD118 have been discovered to cause LCC. Case Presentation: We here report a genetically confirmed childhood case of LCC. The patient was a 4-year-and-1-month-old boy with focal seizures. The age at onset of his seizure was 10 days after birth. The seizures were well-controlled by antiepileptic treatment but reoccurred twice due to a head impact accident and a fever, respectively. He suffered from a self-limited esotropia and unsteady running gait during the seizure onset. He had the typical neuroimaging triad of multifocal intracranial calcifications, cysts, and leukoencephalopathy. Genetic analysis indicated that he carried compound heterozygous variants of n.*9C>T and n.3C>T in SNORD118, which were inherited from his parents. Conclusion: We report a childhood LCC case with compound heterozygous variants in SNORD118. To the best of our knowledge, the patient reported in our case had the youngest onset age of LCC with a determined genotype. The triad cerebral-imaging findings of calcifications, cysts, and leukoencephalopathy provide a crucial diagnostic basis. Moreover, the gene assessment, together with the clinical investigations, should be considered for the diagnosis of LCC.
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Affiliation(s)
- Hong Jin
- Department of Neurology, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, China
| | - Xiaotun Ren
- Department of Neurology, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, China
| | - Husheng Wu
- Department of Neurology, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, China
| | | | - Fang Fang
- Department of Neurology, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, China
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Rosinsky PJ, Yelton MJ, Ankem HK, Meghpara MB, Maldonado DR, Shapira J, Yelton BR, Lall AC, Domb BG. Pertrochanteric Calcifications in Patients With Greater Trochanteric Pain Syndrome: Description, Prevalence, and Correlation With Intraoperatively Diagnosed Hip Abductor Tendon Injuries. Am J Sports Med 2021; 49:1759-1768. [PMID: 33956532 DOI: 10.1177/03635465211008104] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Pertrochanteric calcifications can be found in patients with greater trochanteric pain syndrome (GTPS). A systematic description of the types and prevalence of these calcifications has not been undertaken. Furthermore, there is conflicting evidence regarding their association with abductor tendon injuries. PURPOSE (1) To describe the various types and prevalence of pertrochanteric calcifications in patients presenting for the surgical management of recalcitrant GTPS. (2) To evaluate the association of the various calcifications with intraoperatively diagnosed hip abductor tendon injuries, including tendinosis, partial-thickness tears, and full-thickness tears. STUDY DESIGN Cross-sectional study; Level of evidence, 3. METHODS Patients undergoing surgical management for GTPS, in isolation or as an ancillary procedure during hip arthroscopy for femoroacetabular impingement, between April 2008 and February 2020 were included. Of these, 85 procedures were isolated treatment of GTPS and the remaining 628 were ancillary to hip arthroscopy. Radiographs were scrutinized for the presence of pertrochanteric calcifications. The hip abductor tendon status was intraoperatively classified as intact, partial-thickness tear, or full-thickness tear. The prevalence and correlation of the various radiographic findings in relation to the intraoperatively classified tendon condition were analyzed via the odds ratio (OR). RESULTS Surgery was performed on 713 hips with recalcitrant GTPS. No tear was found in 340 hips (47.7%), 289 hips (40.5%) had a partial-thickness tear, and 84 hips (11.8%) had a full-thickness tear. Radiographically, 102 hips (14.3%) demonstrated proximally directed enthesophytes, and 34 (4.8%) had distally directed enthesophytes. In addition, 75 hips (10.5%) had amorphous calcifications, 47 (6.6%) had isolated ossicles, and 110 (15.4%) had surface irregularities. The presence of any calcification was associated with partial-thickness tears (OR, 1.67 [95% CI, 1.21-2.21]; P = .002) and full-thickness tears (OR, 6.40 [95% CI, 3.91-10.47]; P < .001). Distally directed enthesophytes (OR, 10.18 [95% CI, 3.08-33.63]; P < .001) and proximally directed enthesophytes (OR, 8.69 [95% CI, 4.66-16.21]; P < .001) were the findings with the highest OR for the presence of any type of tear. Distally directed enthesophytes were the findings with the highest OR for a full-thickness tear (OR, 15.79 [95% CI, 7.55-33.06]; P < .001). Isolated ossicles were the findings with the highest OR for a partial-thickness tear (OR, 1.73 [95% CI, 0.96-3.13]; P = .070). CONCLUSION Pertrochanteric calcifications were common radiographic findings in patients with GTPS and can help guide management in these patients. Proximally and distally directed enthesophytes were strong predictors for the presence of a hip abductor tendon tear, and specifically a full-thickness tear, and increasing size of the findings was associated with more severe tendon injuries.
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Affiliation(s)
| | | | - Hari K Ankem
- American Hip Institute Research Foundation, Chicago, Illinois, USA
| | - Mitchell B Meghpara
- American Hip Institute Research Foundation, Chicago, Illinois, USA.,AMITA Health St Alexius Medical Center, Hoffman Estates, Illinois, USA
| | | | - Jacob Shapira
- American Hip Institute Research Foundation, Chicago, Illinois, USA
| | - Brent R Yelton
- Oakland University William Beaumont School of Medicine, Auburn Hills, Michigan, USA
| | - Ajay C Lall
- American Hip Institute Research Foundation, Chicago, Illinois, USA.,AMITA Health St Alexius Medical Center, Hoffman Estates, Illinois, USA.,American Hip Institute, Chicago, Illinois, USA
| | - Benjamin G Domb
- American Hip Institute Research Foundation, Chicago, Illinois, USA.,AMITA Health St Alexius Medical Center, Hoffman Estates, Illinois, USA.,American Hip Institute, Chicago, Illinois, USA
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Scaperrotta GP, Boffelli G, Depretto C, Di Leo G, Liguori A, Monaco CG, Anna B, Ferranti C. Guiding vacuum-assisted biopsy in prone position: digital breast tomosynthesis vs stereotactic. Tumori 2021; 108:326-330. [PMID: 34041978 DOI: 10.1177/03008916211016101] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
PURPOSE To compare the performance of prone digital breast tomosynthesis (DBT)-vacuum-assisted biopsy (VAB) with prone stereotactic-guided VAB (sVAB), focusing on time of procedure, number of expositions, average glandular dose, and complications. METHODS The institutional review board approved this retrospective study and informed consent was waived. From July 2015 to January 2017, 306 patients with 306 suspicious mammographic findings (BI-RADS ⩾4) underwent mammography-guided biopsy, prone sVAB, or prone DBT-VAB. Student t test, chi-square, and multivariate regression statistics were used. RESULTS During the study period, 155 prone sVAB procedures in 155 patients (mean age, 56 years; age range, 39-84 years) and 151 DBT-VABs in 151 patients (mean age, 57 years; age range, 33-84 years) were performed. Mean procedure time was shorter with DBT-VAB versus sVAB (14.5 versus 17.4 minutes, respectively; p < 0.001), and fewer images were acquired with DBT-VAB versus sVAB (8 vs 11, respectively; p < 0.001); the average glandular dose was significantly lower in DBT-VAB versus sVAB (11.8 mGy versus 18 mGy, respectively; p < 0.001). There were no differences in the distribution of histologic results (p = 0.74) or breast density (p = 0.09) between the two groups. No major complications were observed in either group. CONCLUSION Performance of prone DBT-VAB was superior to prone sVAB because it allowed a faster procedure with fewer radiologic expositions and lower radiation dose.
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Gheban BA, Colosi HA, Gheban-Rosca IA, Pop B, Domșa AMT, Georgiu C, Gheban D, Crișan D, Crișan M. Age-Related Changes of the Pineal Gland in Humans: A Digital Anatomo-Histological Morphometric Study on Autopsy Cases with Comparison to Predigital-Era Studies. ACTA ACUST UNITED AC 2021; 57:medicina57040383. [PMID: 33921100 PMCID: PMC8071372 DOI: 10.3390/medicina57040383] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2021] [Revised: 04/13/2021] [Accepted: 04/14/2021] [Indexed: 12/28/2022]
Abstract
Background and objectives: The pineal gland is a photoneuroendocrine organ in the midline of the brain, responsible primarily for melatonin synthesis. It is composed mainly of pinealocytes and glial tissue. This study examined human postmortem pineal glands to microscopically assess age-related changes using digital techniques, and offers a perspective on evolutionary tendencies compared to the past. Materials and Methods: A retrospective autopsy study has been performed on 72 pediatric and adult autopsy cases. The glands have been processed for histological analysis and immunohistochemical staining with glial fibrillary acidic protein (GFAP). Slides were assessed under polarized light and digitally scanned. Morphometric data were obtained using CaseViewer and ImageJ. Results: Thirty-three females and 39 males were included in the study, grouped under three age groups: 0–25, 46–65, and 66–96 years of age. The peak gland volume was found within the 46–65 age group, the overall mean volume was 519 mm3, the main architectural types were lobular and insular, and the mean percentage of pineal calcification was 15% of the gland, peaking within the 66–96 age group, with a predominantly globular shape. Glial cysts were found in 20.8% of cases. The intensity of GFAP stain was maximal in the pediatric age group, but the extent of glial tissue was much larger in elderly patients. Discussion: The degenerative process of the pineal gland can be quantified by measuring normal parenchyma, calcifications, glial tissue, and glial cysts. Morphometric differences have been observed and compared to a similar studies performed in the published literature. The current study, unfortunately, lacks a 26–45 age group. Digital techniques seemed to offer a more exact analysis, but returned similar results to studies performed over 40 years ago, therefore offering important information on evolutionary tendencies. Conclusions: Increase in glial tissue, calcifications, and glial cysts have a defining role as age-related changes in the pineal gland.
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Affiliation(s)
- Bogdan-Alexandru Gheban
- Department of Anatomic Pathology, Iuliu Hațieganu University of Medicine and Pharmacy, 400129 Cluj-Napoca, Romania; (B.P.); (A.-M.T.D.); (C.G.); (D.G.); (D.C.)
- Emergency Clinical County Hospital, 400129 Cluj-Napoca, Romania;
- Correspondence: (B.-A.G.); (H.A.C.)
| | - Horațiu Alexandru Colosi
- Department of Medical Informatics and Biostatistics, Iuliu Hațieganu University of Medicine and Pharmacy, 400129 Cluj-Napoca, Romania
- Correspondence: (B.-A.G.); (H.A.C.)
| | | | - Bogdan Pop
- Department of Anatomic Pathology, Iuliu Hațieganu University of Medicine and Pharmacy, 400129 Cluj-Napoca, Romania; (B.P.); (A.-M.T.D.); (C.G.); (D.G.); (D.C.)
- The Oncology Institute “Ion Chiricuţă”, 400015 Cluj-Napoca, Romania;
| | - Ana-Maria Teodora Domșa
- Department of Anatomic Pathology, Iuliu Hațieganu University of Medicine and Pharmacy, 400129 Cluj-Napoca, Romania; (B.P.); (A.-M.T.D.); (C.G.); (D.G.); (D.C.)
| | - Carmen Georgiu
- Department of Anatomic Pathology, Iuliu Hațieganu University of Medicine and Pharmacy, 400129 Cluj-Napoca, Romania; (B.P.); (A.-M.T.D.); (C.G.); (D.G.); (D.C.)
- Emergency Clinical County Hospital, 400129 Cluj-Napoca, Romania;
| | - Dan Gheban
- Department of Anatomic Pathology, Iuliu Hațieganu University of Medicine and Pharmacy, 400129 Cluj-Napoca, Romania; (B.P.); (A.-M.T.D.); (C.G.); (D.G.); (D.C.)
- Children’s Emergency Clinical Hospital, 400000 Cluj-Napoca, Romania
| | - Doinița Crișan
- Department of Anatomic Pathology, Iuliu Hațieganu University of Medicine and Pharmacy, 400129 Cluj-Napoca, Romania; (B.P.); (A.-M.T.D.); (C.G.); (D.G.); (D.C.)
- Emergency Clinical County Hospital, 400129 Cluj-Napoca, Romania;
| | - Maria Crișan
- Emergency Clinical County Hospital, 400129 Cluj-Napoca, Romania;
- Department of Histology, Iuliu Hațieganu University of Medicine and Pharmacy, 400129 Cluj-Napoca, Romania
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Iotti V, Ragazzi M, Besutti G, Marchesi V, Ravaioli S, Falco G, Coiro S, Bisagni A, Gasparini E, Giorgi Rossi P, Vacondio R, Pattacini P. Accuracy and Reproducibility of Contrast-Enhanced Mammography in the Assessment of Response to Neoadjuvant Chemotherapy in Breast Cancer Patients with Calcifications in the Tumor Bed. Diagnostics (Basel) 2021; 11:diagnostics11030435. [PMID: 33806306 PMCID: PMC7999407 DOI: 10.3390/diagnostics11030435] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2020] [Revised: 02/16/2021] [Accepted: 02/25/2021] [Indexed: 12/31/2022] Open
Abstract
This study aimed to evaluate contrast-enhanced mammography (CEM) accuracy and reproducibility in the detection and measurement of residual tumor after neoadjuvant chemotherapy (NAC) in breast cancer (BC) patients with calcifications, using surgical specimen pathology as the reference. Pre- and post-NAC CEM images of 36 consecutive BC patients receiving NAC in 2012–2020, with calcifications in the tumor bed at diagnosis, were retrospectively reviewed by two radiologists; described were absence/presence and size of residual disease based on contrast enhancement (CE) only and CE plus calcifications. Twenty-eight patients (77.8%) had invasive and 5 (13.9%) in situ-only residual disease at surgical specimen pathology. Considering CE plus calcifications instead of CE only, CEM sensitivity for invasive residual tumor increased from 85.7% (95% CI = 67.3–96%) to 96.4% (95% CI = 81.7–99.9%) and specificity decreased from 5/8 (62.5%; 95% CI = 24.5–91.5%) to 1/8 (14.3%; 95% CI = 0.4–57.9%). For in situ-only residual disease, false negatives decreased from 3 to 0 and false positives increased from 1 to 2. CEM pathology concordance in residual disease measurement increased (R squared from 0.38 to 0.45); inter-reader concordance decreased (R squared from 0.79 to 0.66). Considering CE plus calcifications to evaluate NAC response in BC patients increases sensitivity in detection and accuracy in measurement of residual disease but increases false positives.
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Affiliation(s)
- Valentina Iotti
- Radiology Unit, Department of Imaging and Laboratory Medicine, Azienda USL—IRCCS di Reggio Emilia, 42122 Reggio Emilia, Italy; (V.I.); (V.M.); (S.R.); (R.V.); (P.P.)
| | - Moira Ragazzi
- Pathology Unit, Azienda USL—IRCCS di Reggio Emilia, 42122 Reggio Emilia, Italy; (M.R.); (A.B.)
| | - Giulia Besutti
- Radiology Unit, Department of Imaging and Laboratory Medicine, Azienda USL—IRCCS di Reggio Emilia, 42122 Reggio Emilia, Italy; (V.I.); (V.M.); (S.R.); (R.V.); (P.P.)
- Clinical and Experimental Medicine PhD Program, University of Modena and Reggio Emilia, 41121 Modena, Italy
- Correspondence: ; Tel.: +39-0522-296369
| | - Vanessa Marchesi
- Radiology Unit, Department of Imaging and Laboratory Medicine, Azienda USL—IRCCS di Reggio Emilia, 42122 Reggio Emilia, Italy; (V.I.); (V.M.); (S.R.); (R.V.); (P.P.)
| | - Sara Ravaioli
- Radiology Unit, Department of Imaging and Laboratory Medicine, Azienda USL—IRCCS di Reggio Emilia, 42122 Reggio Emilia, Italy; (V.I.); (V.M.); (S.R.); (R.V.); (P.P.)
| | - Giuseppe Falco
- Breast Surgery Unit, Azienda USL—IRCCS di Reggio Emilia, 42122 Reggio Emilia, Italy; (G.F.); (S.C.)
| | - Saverio Coiro
- Breast Surgery Unit, Azienda USL—IRCCS di Reggio Emilia, 42122 Reggio Emilia, Italy; (G.F.); (S.C.)
| | - Alessandra Bisagni
- Pathology Unit, Azienda USL—IRCCS di Reggio Emilia, 42122 Reggio Emilia, Italy; (M.R.); (A.B.)
| | - Elisa Gasparini
- Oncology Unit, Azienda USL—IRCCS di Reggio Emilia, 42122 Reggio Emilia, Italy;
| | - Paolo Giorgi Rossi
- Epidemiology Unit, Azienda USL—IRCCS di Reggio Emilia, 42122 Reggio Emilia, Italy;
| | - Rita Vacondio
- Radiology Unit, Department of Imaging and Laboratory Medicine, Azienda USL—IRCCS di Reggio Emilia, 42122 Reggio Emilia, Italy; (V.I.); (V.M.); (S.R.); (R.V.); (P.P.)
| | - Pierpaolo Pattacini
- Radiology Unit, Department of Imaging and Laboratory Medicine, Azienda USL—IRCCS di Reggio Emilia, 42122 Reggio Emilia, Italy; (V.I.); (V.M.); (S.R.); (R.V.); (P.P.)
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Helman G, Viaene AN, Takanohashi A, Breur M, Berger R, Woidill S, Cottrell JR, Schiffmann R, Crow YJ, Simons C, Bugiani M, Vanderver A. Cerebral Microangiopathy in Leukoencephalopathy With Cerebral Calcifications and Cysts: A Pathological Description. J Child Neurol 2021; 36:133-140. [PMID: 32988269 DOI: 10.1177/0883073820958330] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Leukoencephalopathy with calcifications and cysts (LCC) is a neurological syndrome recently associated with pathogenic variants in SNORD118. We report autopsy neuropathological findings from an individual with genetically confirmed LCC. Histologic studies included staining of formalin-fixed paraffin-embedded tissue sections by hematoxylin and eosin, elastic van Gieson, and luxol fast blue. Immunohistochemistry stains against glial fibrillary acidic protein, proteolipid protein, phosphorylated neurofilament, CD31, alpha-interferon, LN3, and inflammatory markers were performed. Gross examination revealed dark tan/gray appearing white matter with widespread calcifications. Microscopy revealed a diffuse destructive process due to a vasculopathy with secondary ischemic lesions and mineralization. The vasculopathy involved clustered small vessels, resembling vascular malformations, and sporadic lymphocytic infiltration of vessel walls. The white matter was also diffusely abnormal, with concurrent loss of myelin and axons, tissue rarefaction with multifocal cystic degeneration, and the presence of foamy macrophages, secondary calcifications, and astrogliosis. The midbrain, pons, and cerebellum were diffusely involved. It is not understood why variants in SNORD118 result in a disorder that predominantly causes neurological disease and significantly disrupts the cerebral vasculature. Clinical and radiological benefit was recently reported in an LCC patient treated with Bevacizumab; it is important that these patients are rapidly diagnosed and trial of this treatment modality is considered in appropriate circumstances.
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Affiliation(s)
- Guy Helman
- 34361Murdoch Children's Research Institute, The Royal Children's Hospital Melbourne, Parkville, Melbourne, Australia.,Institute for Molecular Bioscience, The University of Queensland, Brisbane, Australia
| | - Angela N Viaene
- Department of Pathology and Laboratory Medicine, 6567Children's Hospital of Philadelphia, Philadelphia, PA, USA.,Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Asako Takanohashi
- Division of Neurology, 6567Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Marjolein Breur
- Department of Pediatrics/Child Neurology, 1209VU University Medical Centre, Amsterdam Neuroscience, Amsterdam, the Netherlands.,Department of Pathology, 1209VU University Medical Centre, Amsterdam Neuroscience, Amsterdam, the Netherlands
| | - Rebecca Berger
- Department of Pathology and Laboratory Medicine, 6567Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Sarah Woidill
- Division of Neurology, 6567Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - John R Cottrell
- University of Maryland Brain and Tissue Bank, College Park, MD, USA
| | - Raphael Schiffmann
- Institute of Metabolic Disease, Baylor Scott & White Research Institute, Dallas, TX, USA
| | - Yanick J Crow
- Centre for Genomics and Experimental Medicine, MRC Institute of Genetics and Molecular Medicine, University of Edinburgh, Edinburgh, UK.,Laboratory of Neurogenetics and Neuroinflammation, Paris Descartes University, Institut Imagine, Paris, France
| | - Cas Simons
- 34361Murdoch Children's Research Institute, The Royal Children's Hospital Melbourne, Parkville, Melbourne, Australia.,Institute for Molecular Bioscience, The University of Queensland, Brisbane, Australia
| | - Marianna Bugiani
- Department of Pediatrics/Child Neurology, 1209VU University Medical Centre, Amsterdam Neuroscience, Amsterdam, the Netherlands.,Department of Pathology, 1209VU University Medical Centre, Amsterdam Neuroscience, Amsterdam, the Netherlands
| | - Adeline Vanderver
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.,Division of Neurology, 6567Children's Hospital of Philadelphia, Philadelphia, PA, USA
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Wiktorowicz A, Wit A, Malinowski KP, Dziewierz A, Rzeszutko L, Dudek D, Kleczynski P. Paravalvular leak prediction after transcatheter aortic valve replacement with self-expandable prosthesis based on quantitative aortic calcification analysis. Quant Imaging Med Surg 2021; 11:652-664. [PMID: 33532265 DOI: 10.21037/qims-20-669] [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] [Indexed: 11/06/2022]
Abstract
Background Paravalvular leak (PVL) is one of the most common complications of transcatheter aortic valve replacement (TAVR) and affects short- and long-term outcomes. The aim of this study was to identify the computed tomography (CT) imaging biomarkers that allow PVL after TAVR to be predicted. Methods Patients were included who had severe aortic valve stenosis, had undergone TAVR with a self-expanding valve, and had undergone a pre-procedural CT scan. Data on baseline characteristics, procedural and long-term outcomes were collected retrospectively. We used MATLAB software with a self-developed algorithm for CT scan analysis and found parameters that quantified aortic valve calcifications (AVC) in detail. Results Fifty patients were included. The identified CT-derived parameters included AVC size, volume, thickness and density, as well as calcium radial distribution. The volume of the largest calcium block, calcium perimeter and calcium size (assessed by Feret's diameter) showed a strong association with PVL occurrence after TAVR (P=0.012, P=0.001 and P=0.045, respectively). The prognostic model showed that a 10 mm2 increase in the local AVC amount in each valve section was associated with a 9.8% (95% CI: 2-18%; P=0.019) increase in the risk of PVL occurrence in the corresponding area after TAVR. ROC analysis revealed that the cut-off point of the AVC area was 96.5 mm2 in the polar coordinate system presentation. Kaplan-Meier curves showed worse PVL-free survival in patients with more than 96.5 mm2 of calcium area (P=0.013; log-rank). Conclusions Quantitative AVC assessment for PVL prediction may play an important role in screening before TAVR. In future, the use of quantitative AVC assessment as an imaging biomarker in TAVR candidates and the creation and extension of an online database containing quantitative AVC parameters may help to identify high PVL risk patients.
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Affiliation(s)
- Agata Wiktorowicz
- Jagiellonian University Medical College, Faculty of Medicine, Institute of Cardiology, 2 Department of Cardiology, 30-688, Krakow, Poland
| | - Adrian Wit
- Faculty of Physics and Applied Computer Science, AGH University of Science and Technology, 30-059 Krakow, Poland
| | - Krzysztof Piotr Malinowski
- Jagiellonian University Medical College, Faculty of Medicine, Institute of Cardiology, 2 Department of Cardiology, 30-688, Krakow, Poland
| | - Artur Dziewierz
- Jagiellonian University Medical College, Faculty of Medicine, Institute of Cardiology, 2 Department of Cardiology, 30-688, Krakow, Poland
| | - Lukasz Rzeszutko
- Jagiellonian University Medical College, Faculty of Medicine, Institute of Cardiology, 2 Department of Cardiology, 30-688, Krakow, Poland
| | - Dariusz Dudek
- Jagiellonian University Medical College, Faculty of Medicine, Institute of Cardiology, 2 Department of Cardiology, 30-688, Krakow, Poland
| | - Pawel Kleczynski
- Jagiellonian University Medical College, Faculty of Medicine, Institute of Cardiology, Department of Interventional Cardiology, John Paul II Hospital, 31-202 Krakow, Poland
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Shen L, Ma X, Jiang T, Shen X, Yang W, You C, Peng W. Malignancy Risk Stratification Prediction of Amorphous Calcifications Based on Clinical and Mammographic Features. Cancer Manag Res 2021; 13:235-245. [PMID: 33469367 PMCID: PMC7811441 DOI: 10.2147/cmar.s286269] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [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: 10/13/2020] [Accepted: 12/17/2020] [Indexed: 12/16/2022] Open
Abstract
Purpose To explore the potential factors influencing the malignancy risk of amorphous calcifications and establish a predictive nomogram for malignancy risk stratification. Patients and Methods Consecutive mammograms from January 2013 to December 2018 were retrospectively reviewed. Traditional clinical features were recorded, and mammographic features were estimated according to the 5th BI-RADS. Included calcifications were randomly divided into the training and validation cohorts. A nomogram was developed to graphically predict the risk of malignancy (risk) based on stepwise multivariate logistic regression analysis. The discrimination and calibration performance of the model were assessed in both the training and validation cohorts. Results Finally, 1018 amorphous calcifications with final pathological results in 907 women were identified with a malignancy rate of 28.4% (95% CI: 25.7%, 31.3%). The malignancy rates of subgroups divided by the distribution of calcifications, quantity of calcifications, age, menopausal status and family history of cancer were significantly different. There were 712 cases and 306 cases in the training and validation cohorts. The prediction nomogram was finally developed based on four risk factors, including age and distribution, maximum diameter and quantity of calcifications. The AUC of the nomogram was 0.799 (95% CI: 0.761, 0.836) in the training cohort and 0.795 (95% CI: 0.738, 0.852) in the validation cohort. Conclusion On mammography, the distribution, maximum diameter and quantity of calcifications are independent predictors of malignant amorphous calcifications and can be easily obtained in the clinic. The nomogram developed in this study for individualized malignancy risk stratification of amorphous calcifications shows good discrimination performance.
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Affiliation(s)
- Lijuan Shen
- Shanghai Institute of Medical Imaging, Shanghai, People's Republic of China.,Department of Radiology, Fudan University Shanghai Cancer Center, Shanghai, People's Republic of China
| | - Xiaowen Ma
- Department of Radiology, Fudan University Shanghai Cancer Center, Shanghai, People's Republic of China.,Department of Oncology, Fudan University Shanghai Cancer Center, Shanghai, People's Republic of China
| | - Tingting Jiang
- Department of Radiology, Fudan University Shanghai Cancer Center, Shanghai, People's Republic of China.,Department of Oncology, Fudan University Shanghai Cancer Center, Shanghai, People's Republic of China
| | - Xigang Shen
- Department of Radiology, Fudan University Shanghai Cancer Center, Shanghai, People's Republic of China.,Department of Oncology, Fudan University Shanghai Cancer Center, Shanghai, People's Republic of China
| | - Wentao Yang
- Department of Oncology, Fudan University Shanghai Cancer Center, Shanghai, People's Republic of China.,Department of Pathology, Fudan University Shanghai Cancer Center, Shanghai, People's Republic of China
| | - Chao You
- Department of Radiology, Fudan University Shanghai Cancer Center, Shanghai, People's Republic of China.,Department of Oncology, Fudan University Shanghai Cancer Center, Shanghai, People's Republic of China
| | - Weijun Peng
- Department of Radiology, Fudan University Shanghai Cancer Center, Shanghai, People's Republic of China.,Department of Oncology, Fudan University Shanghai Cancer Center, Shanghai, People's Republic of China
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Nigam JS, Tewari P, Prasad T, Kumar T, Kumar A. Carcinoma Breast-Like Giant Complex Fibroadenoma: A Clinical Masquerade. Cureus 2021; 13:e12611. [PMID: 33585101 PMCID: PMC7872482 DOI: 10.7759/cureus.12611] [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] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Fibroadenoma (FA) is a benign, painless, solid breast tumor that commonly occurs in young adult females. The term complex FA is used when it is associated with any of the following: cyst >3 mm, epithelial calcifications, sclerosing adenosis, or papillary apocrine metaplasia. FAs of size more than 5 cm or weighing more than 500 g are considered as giant FAs. Giant FAs are rare, and because of hormonal sensitivity, they commonly occur in pregnant or lactating women. We report the case of a 26-year-old female with a large breast mass that was clinically as well as grossly masquerading as breast carcinoma and turned out to be a giant complex FA on microscopy.
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Affiliation(s)
- Jitendra S Nigam
- Pathology/Lab Medicine, All India Institute of Medical Sciences, Patna, IND
| | - Prerna Tewari
- Pathology/Lab Medicine, All India Institute of Medical Sciences, Patna, IND
| | - Tanya Prasad
- Pathology/Lab Medicine, All India Institute of Medical Sciences, Patna, IND
| | - Tarun Kumar
- Pathology/Lab Medicine, All India Institute of Medical Sciences, Patna, IND
| | - Anil Kumar
- Surgery, All India Institute of Medical Sciences, Patna, IND
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Lavi A, Nair SM, Halstuch D, Chin JL. Prostatic dystrophic calcification following salvage cryotherapy for prostate cancer - an under-reported entity? Scand J Urol 2020; 55:33-35. [PMID: 33222581 DOI: 10.1080/21681805.2020.1849388] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
BACKGROUND Salvage cryoablation (SCA) is an accepted treatment for radio-recurrent prostate cancer with well-established oncological and functional outcomes. Based on one of the longest reported prospective follow-ups in the literature (median 12 years) on 187 patients, this study reports what appears to be an under-appreciated finding in eight patients with dystrophic calcifications (DC) of the prostate following SCA, causing severe bladder outlet obstruction. MATERIALS AND METHODS Between 1995 and 2004, 187 patients underwent SCA, with a median follow-up of 12 years. This database was reviewed for functional and oncological outcomes and DC were evaluated. RESULTS Functional data was available in 85 patients, amongst whom eight patients were found to develop DC (9.4%) proven when the patients presented with urinary difficulties and attempted transurethral resection was undertaken for bladder outlet obstruction. Mean time for emergence of significant symptoms of bladder outlet obstruction was 8.6 years from SCA (standard deviation (SD) = 6 years). All eightpatients required permanent drainage (seven suprapubic catheters, one nephrostomy). All patients with DC experienced biochemical recurrence (BCR), compared to 57.1% of the patients with no DC (p = 0.01). CONCLUSION DC following SCA appears to be an under-reported late adverse effect which may only become evident with long follow-up, and should be included in preoperative counselling.
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Affiliation(s)
- Arnon Lavi
- Urology Division, Department of Surgery, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada
| | - Shiva M Nair
- Urology Division, Department of Surgery, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada
| | - Daniel Halstuch
- Urology Division, Department of Surgery, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada
| | - Joseph L Chin
- Urology Division, Department of Surgery, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada
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Suoub M, Alsbou M, Sawaqed F. Urological Aspects in Patients with Alkaptonuria: A Case-Control Study. Am J Mens Health 2020; 14:1557988320969310. [PMID: 33118482 PMCID: PMC7607800 DOI: 10.1177/1557988320969310] [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] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
This study aimed to evaluate the urinary tract for dynamic function and stones and calcifications in patients with alkaptonuria. Thirty-eight patients were prospectively divided into two groups. Study group (A) involved 17 patients; the average age was 42 years. The control group (B) involved 21 patients; the average age was 37 years. All patients from the two groups underwent uroflowmetry assessment and ultrasonography for the kidneys and urinary bladder, and prostate in two phases (full bladder and empty bladder). Group A-Bladder volume ranged between 400 and 520 cc. The peak flow rate was between 7 and 23 mL/s, with an average of 18.6 mL/s. Flow rate curves shape were acceptable to the normal bell-shape curve in 11 patients. Seven patients (41%) had prostate calcification accounting for 5%-35% of prostate size. Group B-Bladder volume ranged between 290 and 510 cc. The peak flow rate was 8-27 ml/s, with an average of 20 mL/sec. Normal bell shape voiding curves were observed in 17 patients (80%). Four patients (19%) had prostate calcification accounting for 2%-12% of prostate size. Renal measurements on ultrasonography were the same in both groups. Patients with alkaptonuria developed prostate calcification at younger age; they have a slight but not statistically significant reduced peak urinary flow rate and post void residual urine.
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Affiliation(s)
- Mohammed Suoub
- Department of Special Surgery, Faculty of Medicine, Mutah University, Karak, Jordan
| | - Mohammed Alsbou
- Alkaptonuria Research Office, Faculty of Medicine, Mutah University, Karak, Jordan
| | - Fadi Sawaqed
- Department of Special Surgery, Faculty of Medicine, Mutah University, Karak, Jordan
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Bauer E, Fauny M, Tanguy M, Albuisson E, Mandry D, Huttin O, Chabot F, Deibener J, Chary-Valckenaere I, Loeuille D. Relationship between calcifications and structural lesions on hand radiography and axial calcifications on CT-scan: A retrospective study in systemic sclerosis. Medicine (Baltimore) 2020; 99:e22443. [PMID: 33120739 PMCID: PMC7581176 DOI: 10.1097/md.0000000000022443] [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] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
The objectives of this study were to describe the prevalence and characteristics of radiographic lesions of the hands, and calcifications of the spine on computer tomography scans (CT-scans), and to investigate the relationships between radiographic and CT-scan abnormalities and clinical features in a population of patients with systemic sclerosis (SSc).Subjects underwent X-ray examination of the hands, and thoracic or thoraco-abdominal and pelvic CT scan or lumbar CT scan in the year. Structural lesions on hand X ray was scored and spinal calcifications were evaluated in the anterior, intracanal and posterior segments. Intra and inter-reliability was tested for radiography and CT- scan. Prognostic factors considered were interstitial pulmonary lesions on the CT scan, pulmonary arterial hypertension (PAH) and death.This study involved 77 SSc patients, 58 (75%) with limited cutaneous SSc (lcSSc) and 19 (25%) with diffuse SSc (dSSc). The prevalences of radiographic lesions of the hand were 28.6% for periarticular calcifications and 26% for calcinosis. On CT scan, 64 (83%) patients exhibited at least 1 calcification. Spine calcifications were depicted in 80.5%, 27.3%, and 35.1% at the anterior, intracanal and posterior segments respectively. Calcifications were mainly localized on thoracic spine. Inter reader reliabilities were good for hands and moderate for spine respectively. Spine calcifications and periarticular calcifications in the hands were associated (P = .012). Calcinosis in the hands was related to PAH (P = .02). Posterior calcification segment and foraminal calcifications were associated with interstitial lung disease (ILD) (P = .029) and death (P = .001).More than 80% of systemic sclerosis patients presented spine calcifications. A significant association between hands and spinal calcifications were confirmed and some localization in the posterior segment considered as a bad prognostic factor.
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Affiliation(s)
- Elodie Bauer
- Department of Rheumatology, University of Lorraine, CHRU Nancy
| | - Marine Fauny
- Department of Rheumatology, University of Lorraine, CHRU Nancy
| | - Maurice Tanguy
- Pôle S2R, PARC, CHU
- Faculté de médecine, InSciDens, University of Lorraine
- CNRS, Institut Elie Cartan de Lorraine, UMR 7502, 54506, Vandoeuvre-lès-Nancy
| | - Eliane Albuisson
- Pôle S2R, PARC, CHU
- Faculté de médecine, InSciDens, University of Lorraine
- CNRS, Institut Elie Cartan de Lorraine, UMR 7502, 54506, Vandoeuvre-lès-Nancy
| | - Damien Mandry
- Department of Medical Imaging, University of Lorraine, CHRU Nancy
| | - Olivier Huttin
- Department of Cardio-Vascular Medicine, University of Lorraine, Nancy
| | | | - Joelle Deibener
- Department of Internal Medicine, University Hospital, CHRU Nancy
| | | | - Damien Loeuille
- Department of Rheumatology, University of Lorraine, CHRU Nancy
- IMoPA, University of Lorraine, Nancy, France
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Li JW, Chang C, Chen JY, Shi ZT, Chen M. Nodule Size Effect on Diagnostic Performance of Ultrasonography and Computed Tomography for Papillary Thyroid Carcinoma. Curr Med Imaging 2020; 15:489-495. [PMID: 32008556 DOI: 10.2174/1573405614666180425142141] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [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: 11/18/2017] [Revised: 03/12/2018] [Accepted: 03/29/2018] [Indexed: 12/11/2022]
Abstract
BACKGROUND To compare the abilities of ultrasonography (US) and Computed Tomography (CT) to identify calcifications and to predict probability of malignancy for Papillary Thyroid Carcinoma (PTC) and Papillary Thyroid Microcarcinoma (PTMC). METHODS We reviewed 1008 cases of PTC/PTMC with calcifications reported by pre-operative US, CT, or post-operative pathology. The size of the thyroid nodule was obtained from the US report and the maximum diameter (d) was documented. According to the nodule size (d), the PTC and PTMC groups were each divided into two subgroups, as follows: large PTC group (d ≥ 2 cm), small PTC group (1 cm < d < 2 cm), large PTMC group (0.6 cm ≤ d ≤ 1 cm), and small PTMC group (d < 0.6 cm). RESULTS In the 1008 patients, the ratio of females to males was 2.29 and the mean age was 40.9 years (standard deviation: 11.7 years). Of the 1008 records, 92.8% were found to have calcifications according to the US report, while 50.4% showed calcifications according to the CT report. This difference between US and CT reports was statistically significant (p < 0.0005). The percentages of US reports showing calcifications were similar for all four PTC and PTMC subgroups (93.7%, 94.3%, 92.1%, and 85.1%, respectively; p = 0.052), while the percentages of CT reports showing calcifications were significantly different among the PTC and PTMC subgroups (62.3%, 52.2%, 45.4%, and 31.3%, respectively; p < 0.0005). As for the prediction of malignancy, US was superior to CT in all four subgroups (large PTC group: 97.1% vs. 54.1%, small PTC group: 94.8% vs. 42.9%, large PTMC group: 97.2% vs. 32.0%, small PTMC group: 95.5% vs. 14.9%; p < 0.0005 for all pairwise comparisons). No significant difference was observed in terms of the ability of US to predict the malignancy of PTC versus PTMC (p = 0.31), while CT showed significant superiority in diagnosing PTC versus PTMC (p < 0.0005). The predictive value of CT for PTC declined as the nodule size decreased (p < 0.05 for all pairwise comparisons). CONCLUSION Our results showed that US detected calcifications and predicted the malignancy of all nodule sizes of thyroid papillary carcinoma equally well, while the performance of CT declined with the reduction of nodule size.
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Affiliation(s)
- Jia-Wei Li
- Department of Medical Ultrasound, Fudan University Shanghai Cancer Center, Shanghai 200032, China
| | - Cai Chang
- Department of Medical Ultrasound, Fudan University Shanghai Cancer Center, Shanghai 200032, China
| | - Jia-Ying Chen
- Department of Head and Neck Surgery, Fudan University Shanghai Cancer Center; No 270, Dong'an Road, Xuhui District, Shanghai, China
| | - Zhao-Ting Shi
- Department of Medical Ultrasound, Fudan University Shanghai Cancer Center, Shanghai 200032, China
| | - Min Chen
- Department of Medical Ultrasound, Fudan University Shanghai Cancer Center, Shanghai 200032, China
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Ferreira LB, Gimba E, Vinagre J, Sobrinho-Simões M, Soares P. Molecular Aspects of Thyroid Calcification. Int J Mol Sci 2020; 21:E7718. [PMID: 33086487 DOI: 10.3390/ijms21207718] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2020] [Revised: 10/14/2020] [Accepted: 10/15/2020] [Indexed: 02/06/2023] Open
Abstract
In thyroid cancer, calcification is mainly present in classical papillary thyroid carcinoma (PTC) and in medullary thyroid carcinoma (MTC), despite being described in benign lesions and in other subtypes of thyroid carcinomas. Thyroid calcifications are classified according to their diameter and location. At ultrasonography, microcalcifications appear as hyperechoic spots ≤ 1 mm in diameter and can be named as stromal calcification, bone formation, or psammoma bodies (PBs), whereas calcifications > 1 mm are macrocalcifications. The mechanism of their formation is still poorly understood. Microcalcifications are generally accepted as a reliable indicator of malignancy as they mostly represent PBs. In order to progress in terms of the understanding of the mechanisms behind calcification occurring in thyroid tumors in general, and in PTC in particular, we decided to use histopathology as the basis of the possible cellular and molecular mechanisms of calcification formation in thyroid cancer. We explored the involvement of molecules such as runt-related transcription factor-2 (Runx-2), osteonectin/secreted protein acidic and rich in cysteine (SPARC), alkaline phosphatase (ALP), bone sialoprotein (BSP), and osteopontin (OPN) in the formation of calcification. The present review offers a novel insight into the mechanisms underlying the development of calcification in thyroid cancer.
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Zorlu Y, Brown C, Keil C, Ayhan MM, Haase H, Thompson RB, Lengyel I, Yücesan G. Fluorescent Arylphosphonic Acids: Synergic Interactions between Bone and the Fluorescent Core. Chemistry 2020; 26:11129-11134. [PMID: 32293767 PMCID: PMC7496659 DOI: 10.1002/chem.202001613] [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] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2020] [Indexed: 12/23/2022]
Abstract
Herein, we report the third generation of fluorescent probes (arylphosphonic acids) to target calcifications, particularly hydroxyapatite (HAP). In this study, we use highly conjugated porphyrin-based arylphosphonic acids and their diesters, namely 5,10,15,20-tetrakis[m-(diethoxyphosphoryl)phenyl]porphyrin (m-H8 TPPA-OEt8 ) and 5,10,15,20-tetrakis [m-phenylphosphonic acid]porphyrin (m-H8 TPPA), in comparison with their positional isomers 5,10,15,20-tetrakis[p-(diisopropoxyphosphoryl)phenyl]porphyrin (p-H8 TPPA-iPr8 ) and 5,10,15,20-tetrakis [p-phenylphosphonic acid]porphyrin (p-H8 TPPA), which have phosphonic acid units bonded to sp2 carbon atoms of the fluorescent core. The conjugation of the fluorescent core is thus extended to the (HAP) through sp2 -bonded -PO3 H2 units, which generates increased fluorescence upon HAP binding. The resulting fluorescent probes are highly sensitive towards the HAP in rat bone sections. The designed probes are readily taken up by cells. Due to the lower reported toxicity of (p-H8 TPPA), these probes could find applications in monitoring bone resorption or adsorption, or imaging vascular or soft tissue calcifications for breast cancer diagnosis etc.
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Affiliation(s)
- Yunus Zorlu
- Department of ChemistryFaculty of ScienceGebze Technical University41400Gebze-KocaeliTurkey
| | - Connor Brown
- Wellcome-Wolfson Institute for Experimental MedicineSchool of Medicine, Dentistry and Biomedical ScienceQueen's University BelfastBelfastBT9 7BLUK
| | - Claudia Keil
- Technische Universität BerlinChair of Food Chemistry and ToxicologyStraße des 17. Juni 13510623BerlinGermany
| | - M. Menaf Ayhan
- Department of ChemistryFaculty of ScienceGebze Technical University41400Gebze-KocaeliTurkey
| | - Hajo Haase
- Technische Universität BerlinChair of Food Chemistry and ToxicologyStraße des 17. Juni 13510623BerlinGermany
| | - Richard B. Thompson
- Department of Biochemistry and Molecular BiologyUniversity of Maryland School of MedicineBaltimoreMaryland21201USA
| | - Imre Lengyel
- Wellcome-Wolfson Institute for Experimental MedicineSchool of Medicine, Dentistry and Biomedical ScienceQueen's University BelfastBelfastBT9 7BLUK
| | - Gündoğ Yücesan
- Technische Universität BerlinChair of Food Chemistry and ToxicologyStraße des 17. Juni 13510623BerlinGermany
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Haghayeghi K, Najibi M, Wang H, Donegan L, Wang Y. Clinicopathologic update of calcium oxalate in breast: A 15-year retrospective review. Breast J 2020; 26:1736-1741. [PMID: 32564487 DOI: 10.1111/tbj.13952] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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: 02/27/2020] [Revised: 06/05/2020] [Accepted: 06/05/2020] [Indexed: 11/26/2022]
Abstract
Mammary malignancies are radiologically detected by presence of masses, architectural distortions or microcalcifications. Unlike calcium hydroxyapatite, calcium oxalate (CaOx) deposits have been almost exclusively associated with benign mammary processes. The etiology and mechanism of mammary CaOx deposition remains poorly understood, and the original studies elucidating its histopathologic correlation are dated several decades ago. We reviewed radiopathologic findings of breast biopsies and excisions to re-examine the clinicopathologic significance of CaOx deposits and to ascertain potential radiologic characteristics for their identification. Fifty patients from 2004 to 2019 with reported "calcium oxalate" were retrospectively reviewed. CaOx was invariably detected with histopathologic changes of nonproliferative ducts/cysts (90%, 45 of 50), and less commonly, ducts/cysts with usual ductal hyperplasia (10%, 5 of 50). CaOx was missed on one biopsy with a subsequent excision showing apocrine cyst with CaOx. Despite the benign pathological findings, mammographic findings corresponding to CaOx ranged from benign to highly suspicious with 20% categorized as benign (round or punctuate), 22% as intermediate amorphous, 14% as suspicious (coarse/heterogeneous), and 18% as highly suspicious/pleomorphic, respectively. Lobular carcinoma in situ (LCIS) was present in separate fields from CaOx containing benign ducts in two cases which were radiologically characterized as "grouped heterogeneous" and "localized linear." On imaging, more than half of the cases (52.5%) had a corresponding BI-RADS score of 4 and the calcifications were associated with variable distributions and appearances. In conclusion, this is one of the largest studies of CaOx in breast with radiology and pathology correlation. The radiologic appearances of CaOx are nonspecific from benign to highly suspicious. Identification of CaOx on the biopsy is reassuring for a benign diagnosis. Incidental atypical lesions can occur that are often not directly associated with CaOx. CaOx may be overlooked on pathologic evaluation which results in unnecessary surgery. Our findings support close radiologic-pathologic correlation for clinical decision-making pertaining to breast calcifications.
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Affiliation(s)
- Koorosh Haghayeghi
- Department of Pathology and Laboratory Medicine, Rhode Island Hospital and Lifespan Medical Center, Warren Alpert Medical School of Brown University, Providence, RI, USA
| | - Mehran Najibi
- Department of Pathology and Laboratory Medicine, Rhode Island Hospital and Lifespan Medical Center, Warren Alpert Medical School of Brown University, Providence, RI, USA
| | - Hai Wang
- Department of Pathology and Laboratory Medicine, Rhode Island Hospital and Lifespan Medical Center, Warren Alpert Medical School of Brown University, Providence, RI, USA
| | - Linda Donegan
- Department of Diagnostic Imaging, Rhode Island Hospital and Lifespan Medical Center, Warren Alpert Medical School of Brown University, Providence, RI, USA
| | - Yihong Wang
- Department of Pathology and Laboratory Medicine, Rhode Island Hospital and Lifespan Medical Center, Warren Alpert Medical School of Brown University, Providence, RI, USA
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Wiktorowicz A, Wit A, Dziewierz A, Rzeszutko L, Dudek D, Kleczynski P. Calcium Pattern Assessment in Patients with Severe Aortic Stenosis Via the Chou's 5-Steps Rule. Curr Pharm Des 2020; 25:3769-3775. [PMID: 31566130 DOI: 10.2174/1381612825666190930101258] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [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: 05/13/2019] [Accepted: 09/26/2019] [Indexed: 02/07/2023]
Abstract
BACKGROUND Progression of aortic valve calcifications (AVC) leads to aortic valve stenosis (AS). Importantly, the AVC degree has a great impact on AS progression, treatment selection and outcomes. Methods of AVC assessment do not provide accurate quantitative evaluation and analysis of calcium distribution and deposition in a repetitive manner. OBJECTIVE We aim to prepare a reliable tool for detailed AVC pattern analysis with quantitative parameters. METHODS We analyzed computed tomography (CT) scans of fifty patients with severe AS using a dedicated software based on MATLAB version R2017a (MathWorks, Natick, MA, USA) and ImageJ version 1.51 (NIH, USA) with the BoneJ plugin version 1.4.2 with a self-developed algorithm. RESULTS We listed unique parameters describing AVC and prepared 3D AVC models with color pointed calcium layer thickness in the stenotic aortic valve. These parameters were derived from CT-images in a semi-automated and repeatable manner. They were divided into morphometric, topological and textural parameters and may yield crucial information about the anatomy of the stenotic aortic valve. CONCLUSION In our study, we were able to obtain and define quantitative parameters for calcium assessment of the degenerated aortic valves. Whether the defined parameters are able to predict potential long-term outcomes after treatment, requires further investigation.
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Affiliation(s)
- Agata Wiktorowicz
- 2nd Department of Cardiology, Institute of Cardiology, Jagiellonian University Medical College, 31-501 Kopernika St. 17, Krakow, Poland
| | - Adrian Wit
- Faculty of Physics and Applied Computer Science, University of Science and Technology, Mickiewicza Ave. 30, 30-059 Krakow, Poland
| | - Artur Dziewierz
- 2nd Department of Cardiology, Institute of Cardiology, Jagiellonian University Medical College, 31-501 Kopernika St. 17, Krakow, Poland
| | - Lukasz Rzeszutko
- 2nd Department of Cardiology, Institute of Cardiology, Jagiellonian University Medical College, 31-501 Kopernika St. 17, Krakow, Poland
| | - Dariusz Dudek
- 2nd Department of Cardiology, Institute of Cardiology, Jagiellonian University Medical College, 31-501 Kopernika St. 17, Krakow, Poland
| | - Pawel Kleczynski
- 2nd Department of Cardiology, Institute of Cardiology, Jagiellonian University Medical College, 31-501 Kopernika St. 17, Krakow, Poland
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Depretto C, Borelli A, Liguori A, Presti G, Vingiani A, Cartia F, Ferranti C, Scaperrotta GP. Contrast-enhanced mammography in the evaluation of breast calcifications: preliminary experience. Tumori 2020; 106:491-496. [PMID: 32515663 DOI: 10.1177/0300891620919170] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
AIM To evaluate the presence of contrast enhancement at the site of calcifications on contrast-enhanced mammography (CEM) and histopathologic results at vacuum-assisted biopsy (VAB), and to examine the association with lesion size and immunohistochemical characteristics, in order to assess disease aggressiveness in malignant lesions. METHODS A total of 34 patients with 36 clusters of suspicious calcifications (BI-RADS 4) were investigated with CEM before the scheduled VAB. We evaluated the presence or absence of enhancement, histologic diagnosis, and, in case of malignant lesions, their size and the expression of Ki-67. RESULTS In our case series, 15/36 (41.7%) lesions were malignant. In 7 cases, contrast enhancement was found at the site of calcifications. Data about size of lesions and immunohistochemical characterization were not available for all malignant cases. In 5 cases with CEM enhancement, all lesions were >5 mm and overexpressing Ki-67 (>20%); in 6 cases with no contrast enhancement, the lesions were <5 mm and with low Ki-67 values (<20%). CONCLUSION Our preliminary study provides indications on the ability of CEM to recognize neoplasms larger than 5 mm, with high proliferative index (Ki-67 >20%), and frequently human epidermal growth factor receptor 2-positive. Our preliminary results suggest that CEM could detect aggressive malignancies. This could be the starting point for planning further studies with larger numbers of cases, in an attempt to reduce overdiagnosis and consequent overtreatment.
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Affiliation(s)
| | | | | | | | - Andrea Vingiani
- Fondazione IRCCS Istituto Nazionale dei Tumori di Milano, Milano, Italy
| | - Francesco Cartia
- Fondazione IRCCS Istituto Nazionale dei Tumori di Milano, Milano, Italy
| | - Claudio Ferranti
- Fondazione IRCCS Istituto Nazionale dei Tumori di Milano, Milano, Italy
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Abstract
BACKGROUND Hypoparathyroidism is a rare endocrine disorder characterized by hypocalcemia and low or undetectable levels of parathyroid hormone. METHODS This review is an evidence-based summary of hypoparathyroidism in terms of relevant pathophysiological, clinical, and therapeutic concepts. RESULTS Many clinical manifestations of hypoparathyroidism are due to the lack of the physiological actions of parathyroid hormone on its 2 major target organs: the skeleton and the kidney. The skeleton is inactive, accruing bone without remodeling it. The kidneys lose the calcium-conserving actions of parathyroid hormone and, thus, excrete a greater fraction of calcium. Biochemical manifestations, besides hypocalcemia and low or undetectable levels of parathyroid hormone, include hyperphosphatemia and low levels of 1,25-dihydroxyvitamin D. Calcifications in the kidney, brain, and other soft tissues are common. Removal of, or damage to, the parathyroid glands at the time of anterior neck surgery is, by far, the most likely etiology. Autoimmune destruction of the parathyroid glands and other genetic causes represent most of the other etiologies. Conventional treatment with calcium and active vitamin D can maintain the serum calcium level but high doses may be required, adding to the risk of long-term soft tissue calcifications. The advent of replacement therapy with recombinant human PTH(1-84) represents a major step in the therapeutics of this disease. CONCLUSIONS Advances in our knowledge of hypoparathyroidism have led to greater understanding of the disease itself and our approach to it.
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Affiliation(s)
- John P Bilezikian
- Department of Medicine, Division of Endocrinology, Vagelos College of Physicians and Surgeons, Columbia University, New York, New York
- Correspondence and Reprint Requests: John P. Bilezikian, Vice-Chair, International Research and Education, Department of Medicine, Vagelos College of Physicians and Surgeons, 630 W. 168th Street, New York, NY 10032. E-mail:
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50
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Bonomo G, Monfrini E, Borellini L, Bonomo R, Arienti F, Saetti MC, Di Fonzo A, Locatelli M. Systemic involvement in adult-onset leukoencephalopathy with intracranial calcifications and cysts (Labrune syndrome) with a novel mutation of the SNORD118 gene. Eur J Neurol 2020; 27:2329-2332. [PMID: 32400930 DOI: 10.1111/ene.14313] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [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: 03/16/2020] [Accepted: 05/05/2020] [Indexed: 11/30/2022]
Abstract
BACKGROUND AND PURPOSE Although Labrune syndrome is a well-known disorder characterized by a typical neuroradiological triad, namely leukoencephalopathy, intracranial calcifications and cysts, there are no reports of systemic involvement in this disorder. This paper attempts to describe a peculiar clinical manifestation related to a novel mutation in the SNORD118 gene. METHODS Clinical examination, brain and total-body imaging, and neurophysiological and ophthalmological investigations were performed. Amplification of the SNORD118 gene and Sanger sequencing were integrated to investigate potential causative mutations. RESULTS A 69-year-old woman, with a long history of episodes of vertigo and gait imbalance, was referred to our hospital for progressive cognitive and motor deterioration. Computed tomography and magnetic resonance imaging disclosed diffuse bilateral leukoencephalopathy in periventricular and deep white matter, widespread calcifications and numerous cysts in the brain, liver, pancreas and kidneys. The genetic analysis revealed two biallelic variants in the SNORD118 gene, one of which is novel (n.60G>C). CONCLUSIONS This is the first report of adult-onset Labrune syndrome with an unusual systemic involvement presenting a novel mutation in the SNORD118 gene.
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Affiliation(s)
- G Bonomo
- Neurosurgery Unit, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, University of Milan, Milan, Italy
| | - E Monfrini
- Neurology Unit, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy.,Neuroscience Section, Department of Pathophysiology and Transplantation, Dino Ferrari Center, University of Milan, Milan, Italy
| | - L Borellini
- Department of Neuropathophysiology, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, University of Milan, Milan, Italy
| | - R Bonomo
- Experimental Neurology Unit, School of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy
| | - F Arienti
- Neurology Unit, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy.,Neuroscience Section, Department of Pathophysiology and Transplantation, Dino Ferrari Center, University of Milan, Milan, Italy
| | - M C Saetti
- Neurology Unit, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy.,Neuroscience Section, Department of Pathophysiology and Transplantation, Dino Ferrari Center, University of Milan, Milan, Italy
| | - A Di Fonzo
- Neurology Unit, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy.,Neuroscience Section, Department of Pathophysiology and Transplantation, Dino Ferrari Center, University of Milan, Milan, Italy
| | - M Locatelli
- Neurosurgery Unit, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, University of Milan, Milan, Italy.,Neuroscience Section, Department of Pathophysiology and Transplantation, Dino Ferrari Center, University of Milan, Milan, Italy.,Aldo Ravelli Center for Neurotechnology and Experimental Brain Therapeutics, Milan, Italy
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