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Bukhari S, Saati A, Abuhalimeh B, Ouma G. Recurrent Aortic Thromboembolism Associated With TET2 Mutation in Chronic Myelomonocytic Leukemia. J Investig Med High Impact Case Rep 2024; 12:23247096231224366. [PMID: 38214069 PMCID: PMC10787530 DOI: 10.1177/23247096231224366] [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] [Indexed: 01/13/2024] Open
Abstract
Ten-eleven translocation 2 (TET2) plays a pivotal role in epigenetic regulation, cell differentiation, and the inflammatory response. It also mediates the transcriptional regulation for inflammatory cytokines, particularly interleukin-6. While loss-of-function mutation in TET2 has been associated with hematological malignancies, it has been increasingly recognized to cause atherosclerotic disease. The increased atherogenicity is thought to be the result of increased production of pro-inflammatory interleukin-1β cytokines following activation of NLRP3 inflammasomes. We present a unique case of recurrent atherothrombosis in an elderly man who was diagnosed with chronic myelomonocytic leukemia in the setting of TET2 mutation.
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Vangara A, Gullapalli D, Depa JK, Kolagatla S, Ali M, Ganti SS. Beware of the Acute Respiratory Distress Syndrome in a Pulmonary Blastomycosis! J Investig Med High Impact Case Rep 2024; 12:23247096241233042. [PMID: 38375745 PMCID: PMC10880536 DOI: 10.1177/23247096241233042] [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: 10/27/2023] [Revised: 01/24/2024] [Accepted: 01/30/2024] [Indexed: 02/21/2024] Open
Abstract
Blastomyces dermatitidis is a dimorphic fungus that can range from mild to severe disease presentation, including the acute respiratory distress syndrome (ARDS) based on the individual's immunity. Acute respiratory distress syndrome is an uncommon presentation having an incidence of about 10% to 15% but has a high mortality exceeding 90%. This is a case of a 50-year-old female with past medical history of asthma and type 2 diabetes mellitus who presented to the pulmonology clinic with worsening dyspnea for the last 2 months. She also had a lesion in the left lower back, which was draining purulent fluid. Chest radiographs showed bilateral infiltrates and was started empirically on vancomycin and piperacillin-tazobactam. Bronchoalveolar lavage was done and the cultures grew B dermatitidis. The patient was moved to a higher level of care and given amphotericin B. Unfortunately, the patient experienced septic shock, which later deteriorated into cardiac arrest, ultimately leading to their passing. The importance of early diagnosis of blastomycosis and timely treatment has been emphasized in this case report.
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Affiliation(s)
- Avinash Vangara
- Internal Medicine Residency Program, Appalachian Regional Healthcare, Harlan, KY, USA
| | - Dedeepya Gullapalli
- Internal Medicine Residency Program, Appalachian Regional Healthcare, Harlan, KY, USA
| | - Jayaram Krishna Depa
- Internal Medicine Residency Program, Appalachian Regional Healthcare, Harlan, KY, USA
| | - Sandhya Kolagatla
- Internal Medicine Residency Program, Appalachian Regional Healthcare, Whitesburg, KY, USA
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3
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Siegenthaler A, Niforatos S, Loon T, Brady A, Sandhu M, Kravtsov O, Akhtar K. Transformed Testicular Teratoma to Embryonic-Type Neuroectodermal Tumor With Metastasis to Mediastinum. J Investig Med High Impact Case Rep 2023; 11:23247096231218145. [PMID: 38097381 PMCID: PMC10725136 DOI: 10.1177/23247096231218145] [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: 08/11/2023] [Revised: 11/01/2023] [Accepted: 11/16/2023] [Indexed: 12/18/2023] Open
Abstract
Testicular teratomas may present in both prepubertal and adult men; however, the prognosis differs greatly between these 2 populations. In children, teratomas (prepubertal type) most often occur before the age of 4, are generally seen in their pure form, and behave in a benign fashion. In adults (postpubertal type), teratomas are usually part of a mixed germ cell tumor, and they have the potential to be found at metastatic sites, especially following chemotherapy for non-teratomatous germ cell tumor. Analyses of metastases from germ cell tumors and teratomas from the same patient have demonstrated a high degree of concordance in the observed genetic abnormalities. In rare cases, testicular teratoma can transform into a malignant germ cell tumor. One such type of transformation is into a primitive neuroectodermal tumor. These tumors are malignant and often metastasize to the retroperitoneum but may also metastasize to other sites. A multimodal treatment approach is needed, including surgery and adjuvant chemotherapy. We describe a rare case of malignant transformation of a testicular teratoma into a primitive neuroectodermal tumor with metastasis to the mediastinum. The patient was treated with radical orchiectomy, retroperitoneal lymph node dissection, and adjuvant vincristine, adriamycin, and cyclofosfamide alternating with ifosfamide and etoposide (VAC/IE therapy).
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Affiliation(s)
| | | | - Taylor Loon
- State University of New York Upstate Medical University, Syracuse, USA
| | - Amy Brady
- State University of New York Upstate Medical University, Syracuse, USA
| | - Michael Sandhu
- State University of New York Upstate Medical University, Syracuse, USA
| | | | - Komal Akhtar
- State University of New York Upstate Medical University, Syracuse, USA
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4
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Mizera T, Prospero-Ponce C. Recurrent Idiopathic Neuroretinitis: Anti-MOG Positive? J Investig Med High Impact Case Rep 2023; 11:23247096231206619. [PMID: 37942586 PMCID: PMC10637148 DOI: 10.1177/23247096231206619] [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: 08/01/2023] [Revised: 08/29/2023] [Accepted: 09/22/2023] [Indexed: 11/10/2023] Open
Abstract
Neuroretinitis, originally described by Leber at the turn of the 20th century, has long perplexed ophthalmologists due to its multiple recognized causes and often atypical presentation. Optic disk edema and macular star in the affected eye are well-agreed upon findings and are due to increased permeability of blood vessels near the optic disk and in the retina at large. It also is universally painless and presents with a relative afferent pupillary defect (RAPD) in the affected eye or eyes. However, depending on the infectious agent, an underlying autoimmune condition, or undefined idiopathic cause, there can be various degrees of vision loss, visual field loss, progression or recurrence, as well as involvement of the other eye. We present this case of presumed sequential idiopathic neuroretinitis with severe vision and visual field loss with a low-positive anti-MOG test in the border county of El Paso.
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Affiliation(s)
- Thomas Mizera
- Texas Tech University Health Sciences Center El Paso, USA
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5
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Cautha S, Gupta S, Moirangthem V, Okobi T, Chandok T, Penikilapate S, Jain K. Presentation of Colorectal Carcinoma as Abdominal Wall Phlegmon. J Investig Med High Impact Case Rep 2023; 11:23247096221144974. [PMID: 36602163 PMCID: PMC9982373 DOI: 10.1177/23247096221144974] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
Colorectal cancer (CRC) is the third most common malignancy and the second most common deadly cancer worldwide as of 2020. Unusual presentation of this cancer with locally advanced disease is rare and seen in only 5% to 22% of cases. We present the case of a 53-year-old male who had invasive cecal adenocarcinoma with phlegmon of the abdominal wall musculature at presentation and an aggressive course that did not respond to the standard lines of therapy. In the current era of ongoing tremendous developments in colorectal cancer diagnosis and treatment, this uncommon case reminds us that locally advanced CRC is still a challenge to manage. Precision medicine with treatment strategies tailored to an individual's genetic, environmental and lifestyle factors is the current need.
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Hiffa A, Schulte K, Saeed M, Gani I. Massive Chylous Ascites After Living Donor Nephrectomy Successfully Treated With Lymphatic Embolization. J Investig Med High Impact Case Rep 2022; 10:23247096211065631. [PMID: 35038891 PMCID: PMC8771747 DOI: 10.1177/23247096211065631] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Chylous ascites may result from a variety of pathological conditions, most of them from nontraumatic causes, such as congenital defects of the lymphatic system, infections, liver cirrhosis, and malignancy. Rarely, chylous ascites occurs as an iatrogenic complication after left-sided laparoscopic donor nephrectomy (LDN). Injury to the cisterna chyli and its main lymphatic tributaries around the para-aortic region intraoperatively can cause the lymphatic fluid to accumulate. There is currently no standardized treatment for chylous ascites as there have only been 54 cases documented to date. Most patients can be managed with conservative therapy. Recommended guidelines include high-protein and low-fat diet with medium-chain triglycerides. Paracentesis is often used as a diagnostic and therapeutic first-line measure with total parenteral nutrition (TPN), bowel rest, and somatostatin analogue as adjunct therapies. We present a case of massive chylous ascites refractory to conservative therapy. The patient had progressive abdominal distention and unintentional weight gain 2 weeks postoperatively warranting multiple paracenteses of >7 L of chylous fluid. Ultimately, the patient was successfully treated with lymphatic embolization using N-butyl cyanoacrylate glue.
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Amoda O, Alexander E, Abowali H, Uwagbale E, Zaman M. Chronic Eosinophilic Pneumonia Masquerading as a Lung Mass. J Investig Med High Impact Case Rep 2022; 10:23247096211063337. [PMID: 34984937 PMCID: PMC8744161 DOI: 10.1177/23247096211063337] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Lung masses are becoming more common, and although most are tumors, benign or malignant,
some are not solid masses. Many pathologies can present as lung nodules, including lung
cancers, hamartomas, lung abscesses, granulomas, and eosinophilic pneumonia, to name a
few. A 40-year-old woman with a long history of smoking presented with cough and
left-sided chest pain. After multiple imaging studies, she was thought to have a lung
malignancy; however, multiple biopsies proved this was not the case. The histology reports
of 3 to 4 biopsies at separate times indicated chronic inflammation ongoing in the lungs
without any cancer cells present. She was treated for chronic eosinophilic pneumonia with
a resolution of symptoms. The purpose of this case report is to discuss a case that was
initially thought to be a lung mass but found to be chronic eosinophilic pneumonia
manifesting as a lung mass.
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Affiliation(s)
- Oluyemisi Amoda
- Brookdale University Hospital Medical Center, Brooklyn, NY, USA
| | | | - Hesham Abowali
- Brookdale University Hospital Medical Center, Brooklyn, NY, USA
| | - Ese Uwagbale
- Brookdale University Hospital Medical Center, Brooklyn, NY, USA
| | - Mohammed Zaman
- Brookdale University Hospital Medical Center, Brooklyn, NY, USA
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8
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Patti RK, Dalsania N, De Araujo Duarte C, Randhawa G, Somal N, Kupfer Y. Cystic Lung Disease as a Sequela of Severe COVID-19: Case Series. J Investig Med High Impact Case Rep 2022; 10:23247096221095426. [PMID: 35466743 PMCID: PMC9047774 DOI: 10.1177/23247096221095426] [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: 11/16/2022] Open
Abstract
Coronavirus disease 2019 (COVID-19) presented in December 2019 and has persisted since.
The global pandemic has given rise to a novel acute disease process with a continually
rapidly increasing prevalence of chronic disease and associated complications. There is
minimal information on the long-term pulmonary complications of this disease. We present a
series of 9 patient case reports and their respective imaging admitted with COVID-19 acute
respiratory distress syndrome (ARDS) to highlight the cystic lung disease complications
which may arise due to severity and disease progression. Our aim is to raise awareness of
the sequela of COVID-19 ARDS, including its potentially catastrophic long-term
consequences to the respiratory tract involving cystic lung disease.
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9
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Dayco JS, El-Reda Z, Sumbal N, Alhusain R, Raheem S. Perpetually Positive: Post-COVID Interstitial Lung Disease in an Immunocompromised Patient With Diffuse Large B-cell Lymphoma. J Investig Med High Impact Case Rep 2021; 9:23247096211041207. [PMID: 34427155 PMCID: PMC8388223 DOI: 10.1177/23247096211041207] [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: 11/22/2022] Open
Abstract
As more patients recover from COVID-19 infection, long-term complications are beginning to arise. Our case report will explore a debilitating long-term complication, Post-COVID Interstitial Lung Disease (PC-ILD). We will introduce a patient who developed PC-ILD in the setting of diffuse large B-cell lymphoma, outlining a difficult hospital course, including a positive COVID-19 polymerase chain reaction (PCR) for more than 3 months. We will then discuss the human body’s physiological response to the virus and how our patient was not able to adequately mount an immune response. Finally, the pathophysiology of PC-ILD will be explored and correlated with the patient’s subsequent computed tomographic images obtained over a 3-month period. The difficult hospital course and complex medical decision-making outlined in this case report serve as a reminder for health care providers to maintain vigilance in protecting our most vulnerable patient population from such a devastating disease process.
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Affiliation(s)
| | | | - Nabeel Sumbal
- University of Michigan College of Engineering, Ann Arbor, USA
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10
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Hemond CC, Bakshi R, Tauhid S, Sarrosa R, Ryan M, Kamath V, Thomas J, Edwards KR. Exacerbation of Multiple Sclerosis by BRAF/MEK Treatment for Malignant Melanoma: The Central Vein Sign to Distinguish Demyelinating Lesions From Metastases. J Investig Med High Impact Case Rep 2021; 9:23247096211033047. [PMID: 34308699 PMCID: PMC8317246 DOI: 10.1177/23247096211033047] [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: 10/26/2022] Open
Abstract
The emergence of immunomodulators as effective cancer treatments has been an important advance in cancer therapy. The combination therapy of BRAF/MEK inhibition with or without anti-CTLA-4 treatment causes an immunostimulatory effect that has greatly reduced death from melanoma. In this article, we present the case of a patient with prior multiple sclerosis (MS) and who later developed metastatic malignant melanoma, had a marked increase of magnetic resonance imaging (MRI) findings after treatment with the combination of trametinib (MEK) and dabrafenib (BRAF), diagnostic question of metastatic disease versus new MS lesions without brain biopsy is discussed. A healthy 49-year-old man was diagnosed with MS in October 2012. He was stable with an oral disease modifying drug until March of 2016 when the patient discovered a lump in his right groin. Biopsy was positive for S100 and BRAF V600 mutation. Combination MEK/BRAF was given and after immunotherapy an MRI showed 25 new gadolinium-enhancing lesions thought to be metastases. A brain biopsy was recommended but neurology and neuroimaging consultation showed that the MRI was consistent with demyelination (oval/ovoid, homogeneous and open-ring enhancement, and predominance of the central vein sign within lesions) rather than metastasis. Treatment for MS has been successful and there has been no return of his melanoma in 4 years. New immunotherapies are lifesaving but the modulation of the immune system can cause unpredictable events such are markedly increased MS activity. The awareness of the diagnostic value of the central vein sign provided a better outcome for this patient and could be a model in the future for others.
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Affiliation(s)
- Christopher C Hemond
- Brigham & Women's Hospital, Harvard Medical School, Boston, MA, USA.,University of Massachusetts, Worcester, MA, USA
| | - Rohit Bakshi
- Brigham & Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Shahamat Tauhid
- Brigham & Women's Hospital, Harvard Medical School, Boston, MA, USA
| | | | - Madison Ryan
- MS Center of Northeastern New York, Latham, NY, USA
| | | | - James Thomas
- Imagecare, Medical Imaging of Community Care Physicians PC, Latham, NY, USA
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11
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Dhamrah U, Solomon N, Osuoji OC. An Unexpected Case of Malignant Mesothelioma in a Young Woman. J Investig Med High Impact Case Rep 2021; 9:2324709621997245. [PMID: 33629595 PMCID: PMC7926051 DOI: 10.1177/2324709621997245] [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: 11/16/2022] Open
Abstract
A 41-year-old female with a past medical history significant only for right retinal vein occlusion presented with chest pain, cough, and shortness of breath. After being found to have a large right-sided pleural effusion and undergoing a nondiagnostic thoracentesis, a noncontrast chest computed tomography scan revealed multiple diffuse nodules in the right lung with irregular paraspinal pleural thickening. An extensive workup followed, with computed tomography–guided biopsy ultimately revealing the diagnosis. The following report describes the patient presentation, laboratory findings, and extensive clinical investigation, and provides a discussion of the epidemiology, imaging findings, prognosis, and differential diagnoses for the illness in question.
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Affiliation(s)
- Umaima Dhamrah
- Icahn School of Medicine at Mount Sinai, Elmhurst Hospital Center, Elmhurst, NY, USA
| | | | - Olive C Osuoji
- Icahn School of Medicine at Mount Sinai, Elmhurst Hospital Center, Elmhurst, NY, USA
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12
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Bray A, Reyes JVM, Tarlin N, Stern A. Case Series: Hypercalcemia From Granulomatous Silicosis Developing After COVID-19 Infection. J Investig Med High Impact Case Rep 2021; 9:23247096211051206. [PMID: 34654331 PMCID: PMC8521725 DOI: 10.1177/23247096211051206] [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] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2021] [Revised: 08/16/2021] [Accepted: 09/16/2021] [Indexed: 11/18/2022] Open
Abstract
Hypercalcemia is one of the most commonly encountered laboratory abnormalities in clinical medicine. Various causes have been well established. However, it is likely that the novel coronavirus, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), may be a newly found cause of this frequent finding, especially amongst those with a history of cosmetic surgery, specifically by means of silicone injection. In this case series, we describe 2 patients presenting with symptomatic hypercalcemia likely from their prior silicone injections. Interestingly, each patient only developed symptoms of hypercalcemia following infection with SARS-CoV-2.
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Affiliation(s)
- Ashley Bray
- Department of Internal Medicine, Elmhurst Hospital Center, Icahn School of Medicine at Mount Sinai Hospital, New York, NY, USA
| | - Jonathan Vincent M. Reyes
- Department of Internal Medicine, Elmhurst Hospital Center, Icahn School of Medicine at Mount Sinai Hospital, New York, NY, USA
| | - Nancy Tarlin
- Department of Endocrinology, Elmhurst Hospital Center, Icahn School of Medicine at Mount Sinai Hospital, New York, NY, USA
| | - Aaron Stern
- Department of Nephrology, Elmhurst Hospital Center, Icahn School of Medicine at Mount Sinai Hospital, New York, NY, USA
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Frauenfelder C, Shelmerdine SC, Simcock IC, Hall A, Hutchinson JC, Ashworth MT, Arthurs OJ, Butler CR. Micro-CT Imaging of Pediatric Thyroglossal Duct Cysts: A Prospective Case Series. Front Pediatr 2021; 9:746010. [PMID: 34557462 PMCID: PMC8453197 DOI: 10.3389/fped.2021.746010] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2021] [Accepted: 08/16/2021] [Indexed: 12/18/2022] Open
Abstract
Objectives: To determine the feasibility of micro-CT as a high-resolution 3D imaging tool for thyroglossal duct cysts and to evaluate its role augmenting traditional histopathological examination of resected specimens. Methods: A single centre, prospective case series of consecutive children undergoing excision of a thyroglossal duct cyst was performed at a quaternary paediatric referral hospital in the United Kingdom. Consecutive children listed for excision of a thyroglossal duct cyst whose parents agreed to participate were included and there were no exclusion criteria. Results: Surgically excised thyroglossal duct cyst or remnant specimens from five patients (two males, three females) were examined using micro-CT alongside traditional histopathological examination. In all cases, micro-CT imaging was able to demonstrate 3D imaging datasets of the specimens successfully and direct radio-pathological comparisons were made (Figures 1-5, Supplementary Video 1). Conclusions: The study has shown the feasibility and utility of post-operative micro-CT imaging of thyroglossal duct cysts specimens as a visual aid to traditional histopathological examination. It better informs the pathological specimen sectioning using multi-planar reconstruction and volume rendering tools without tissue destruction. In the complex, often arborised relationship between a thyroglossal duct cyst and the hyoid, micro-CT provides valuable image plane orientation and indicates proximity of the duct to the surgical margins. This is the first case series to explore the use of micro-CT imaging for pediatric thyroglossal duct specimens and it informs future work investigating the generalizability of micro-CT imaging methods for other lesions, particularly those from the head and neck region where precisely defining margins of excision may be challenging.
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Affiliation(s)
- Claire Frauenfelder
- Great Ormond Street Hospital for Children NHS Foundation Trust, London, United Kingdom.,Discipline of Surgery, School of Medicine, University of Adelaide, Adelaide, SA, Australia
| | - Susan C Shelmerdine
- Great Ormond Street Hospital for Children NHS Foundation Trust, London, United Kingdom.,UCL Great Ormond Street Institute of Child Health, Great Ormond Street Hospital for Children, London, United Kingdom.,National Institute for Health Research Great Ormond Street Hospital Biomedical Research Centre, London, United Kingdom
| | - Ian C Simcock
- Great Ormond Street Hospital for Children NHS Foundation Trust, London, United Kingdom.,UCL Great Ormond Street Institute of Child Health, Great Ormond Street Hospital for Children, London, United Kingdom.,National Institute for Health Research Great Ormond Street Hospital Biomedical Research Centre, London, United Kingdom
| | - Andrew Hall
- Great Ormond Street Hospital for Children NHS Foundation Trust, London, United Kingdom
| | - John Ciaran Hutchinson
- Great Ormond Street Hospital for Children NHS Foundation Trust, London, United Kingdom.,UCL Great Ormond Street Institute of Child Health, Great Ormond Street Hospital for Children, London, United Kingdom.,National Institute for Health Research Great Ormond Street Hospital Biomedical Research Centre, London, United Kingdom.,Department of Histopathology, St Thomas' Hospital, London, United Kingdom
| | - Michael T Ashworth
- Great Ormond Street Hospital for Children NHS Foundation Trust, London, United Kingdom
| | - Owen J Arthurs
- Great Ormond Street Hospital for Children NHS Foundation Trust, London, United Kingdom.,UCL Great Ormond Street Institute of Child Health, Great Ormond Street Hospital for Children, London, United Kingdom.,National Institute for Health Research Great Ormond Street Hospital Biomedical Research Centre, London, United Kingdom
| | - Colin R Butler
- Great Ormond Street Hospital for Children NHS Foundation Trust, London, United Kingdom.,UCL Great Ormond Street Institute of Child Health, Great Ormond Street Hospital for Children, London, United Kingdom
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14
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Gotlib T, Kołodziejczyk P, Kuźmińska M, Bobecka-Wesołowska K, Niemczyk K. Three-dimensional computed tomography analysis of frontoethmoidal cells: A critical evaluation of the International Frontal Sinus Anatomy Classification (IFAC). Clin Otolaryngol 2019; 44:954-960. [PMID: 31397960 DOI: 10.1111/coa.13412] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [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: 03/03/2019] [Revised: 07/16/2019] [Accepted: 08/03/2019] [Indexed: 11/30/2022]
Abstract
OBJECTIVES Two major classifications of frontoethmoidal cells, Lee and Kuhn and the IFAC (International Frontal Sinus Anatomy Classification), distinguish anterior, posterior and medial cells. The European anatomical position paper includes also lateral cells. According to the IFAC, anterior cells push the frontal sinus drainage pathway (FSDP) medially, posteriorly or posteromedially. Posterior cells push the FSDP anteriorly. The only medial cell, pushing the FSDP laterally is the frontal septal cell, which is attached to or located in the interfrontal sinus septum. The aim of this study was to verify the IFAC and characterise cells, which are inconsistent with this classification. DESIGN A radioanatomic analysis. SETTING Tertiary university hospital. PARTICIPANTS One hundred and three Caucasian adult patients with no inflammatory changes in paranasal sinuses CT. MAIN OUTCOMES MEASURE Results of assessment of multiplanar reconstruction of thin slice CT. RESULTS Two types of cells that cannot be classified using the IFAC were found: (a) Lateral cells extending between the skull base and the anterior buttress, pushing the FSDP anteromedially or medially, present in 34 (16.5%) of the sides, (b) Paramedian cells: medially based, not adjacent to the interfrontal septum, pushing the FSDP laterally and posteriorly, present in 33 (16%) of sides. Suprabulla cells and suprabulla frontal cells were found to push the FSDP in directions other than anterior 28% and 31% of the time respectively. CONCLUSIONS Neglecting lateral and paramedian cells may lead to inconsistent results between radioanatomical studies and impede communication between surgeons. They should be included in existing classifications of frontoethmoidal cells.
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Affiliation(s)
- Tomasz Gotlib
- Department of Otolaryngology, Medical University of Warsaw, Warsaw, Poland
| | | | | | | | - Kazimierz Niemczyk
- Department of Otolaryngology, Medical University of Warsaw, Warsaw, Poland
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15
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Bladowska J, Pawłowski T, Fleischer-Stępniewska K, Knysz B, Małyszczak K, Żelwetro A, Rymer W, Inglot M, Waliszewska-Prosół M, Ejma M, Podgórski P, Zimny A, Sąsiadek M. Interferon-free therapy as the cause of white matter tracts and cerebral perfusion recovery in patients with chronic hepatitis C. J Viral Hepat 2019; 26:635-643. [PMID: 30702208 DOI: 10.1111/jvh.13069] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2018] [Accepted: 01/09/2019] [Indexed: 02/06/2023]
Abstract
The purpose of this study was to assess cerebral microstructural and perfusion changes in patients with chronic hepatitis C virus (HCV) infection before and after interferon-free therapy, using advanced magnetic resonance (MR) techniques. Eleven HCV-positive patients underwent diffusion tensor imaging (DTI) and perfusion-weighted imaging (PWI) using a 1.5T MR unit, before and 24 weeks after completion of interferon-free therapy. DTI fractional anisotropy (FA) and apparent diffusion coefficient (ADC) values were obtained from 14 white matter tracts. PWI values of relative cerebral blood volume (rCBV) and relative cerebral blood flow (rCBF) were assessed from 8 areas, including basal ganglia, and cortical and white matter locations. In HCV-positive patients therapy with ombitasvir, paritaprevir boosted with ritonavir and dasabuvir, with or without ribavirin, was scheduled. Cognitive tests were used to assess cognitive function. We found increased FA values after interferon-free therapy compared to values obtained before treatment in HCV patients in almost all white matter tracts. We also observed elevated rCBV values in basal ganglia after therapy. There were significant correlations between improvement in the score of cognitive tests and increased FA values in both inferior fronto-occipital fascicles and left posterior cingulum after treatment. Liver fibrosis regression in elastography, APRI and improvement in cognitive tests were observed. This is the first report of interferon-free therapy as the cause of white matter tracts recovery as well as cerebral perfusion improvement in HCV-infected patients, indicating better functioning of frontal lobes after interferon-free treatment.
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Affiliation(s)
- Joanna Bladowska
- Department of General Radiology, Interventional Radiology and Neuroradiology, Wroclaw Medical University, Wroclaw, Poland
| | - Tomasz Pawłowski
- Division of Psychotherapy and Psychosomatic Medicine, Department of Psychiatry, Wroclaw Medical University, Wroclaw, Poland
| | - Katarzyna Fleischer-Stępniewska
- Department of Infectious Diseases, Liver Diseases and Acquired Immune Deficiency, Wroclaw Medical University, Wroclaw, Poland
| | - Brygida Knysz
- Department of Infectious Diseases, Liver Diseases and Acquired Immune Deficiency, Wroclaw Medical University, Wroclaw, Poland
| | - Krzysztof Małyszczak
- Division of Psychotherapy and Psychosomatic Medicine, Department of Psychiatry, Wroclaw Medical University, Wroclaw, Poland
| | | | - Weronika Rymer
- Department of Infectious Diseases, Liver Diseases and Acquired Immune Deficiency, Wroclaw Medical University, Wroclaw, Poland
| | - Małgorzata Inglot
- Department of Infectious Diseases, Liver Diseases and Acquired Immune Deficiency, Wroclaw Medical University, Wroclaw, Poland
| | | | - Maria Ejma
- Department of Neurology, Wroclaw Medical University, Wroclaw, Poland
| | - Przemysław Podgórski
- Department of General Radiology, Interventional Radiology and Neuroradiology, Wroclaw Medical University, Wroclaw, Poland
| | - Anna Zimny
- Department of General Radiology, Interventional Radiology and Neuroradiology, Wroclaw Medical University, Wroclaw, Poland
| | - Marek Sąsiadek
- Department of General Radiology, Interventional Radiology and Neuroradiology, Wroclaw Medical University, Wroclaw, Poland
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16
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Fokas G, Vaughn VM, Scarfe WC, Bornstein MM. Accuracy of linear measurements on CBCT images related to presurgical implant treatment planning: A systematic review. Clin Oral Implants Res 2019; 29 Suppl 16:393-415. [PMID: 30328204 DOI: 10.1111/clr.13142] [Citation(s) in RCA: 83] [Impact Index Per Article: 16.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/17/2018] [Indexed: 11/30/2022]
Abstract
OBJECTIVE The aim of this systematic review was to identify, review, analyze, and summarize available evidence on the accuracy of linear measurements when using maxillofacial cone beam computed tomography (CBCT) specifically in the field of implant dentistry. MATERIAL AND METHODS The search was undertaken in April 2017 in the National Library of Medicine database (Medline) through its online site (PubMed), followed by searches in the Cochrane, EMBASE, ScienceDirect, and ProQuest Dissertation and Thesis databases. The main inclusion criterion for studies was that linear CBCT measurements were performed for quantitative assessment (e.g., height, width) of the alveolar bone at edentulous sites or measuring distances from anatomical structures related to implant dentistry. The studies should compare these values to clinical data (humans) or ex vivo and/or experimental (animal) findings from a "gold standard." RESULTS The initial search yielded 2,516 titles. In total, 22 studies were included in the final analysis. Of those, two were clinical and 20 ex vivo investigations. The major findings of the review indicate that CBCT provides cross-sectional images that demonstrate high accuracy and reliability for bony linear measurements on cross-sectional images related to implant treatment. A wide range of error has been reported when performing linear measurements on CBCT images, with both over- and underestimation of dimensions in comparison with a gold standard. A voxel size of 0.3 to 0.4 mm is adequate to provide CBCT images of acceptable diagnostic quality for implant treatment planning. CONCLUSIONS CBCT can be considered as an appropriate diagnostic tool for 3D preoperative planning. Nevertheless, a 2 mm safety margin to adjacent anatomic structures should be considered when using CBCT. In clinical practice, the measurement accuracy and reliability of linear measurements on CBCT images are most likely reduced through factors such as patient motion, metallic artefacts, device-specific exposure parameters, the software used, and manual vs. automated procedures.
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Affiliation(s)
- George Fokas
- Oral Rehabilitation, Faculty of Dentistry, The University of Hong Kong, Hong Kong SAR, China
| | - Vida M Vaughn
- Vida M. Vaughn, Kornhauser Health Science Library, University of Louisville, Louisville, Kentucky
| | - William C Scarfe
- Radiology and Imaging Science, Department of Surgical/Hospital Dentistry, University of Louisville School of Dentistry, Louisville, Kentucky
| | - Michael M Bornstein
- Oral and Maxillofacial Radiology, Applied Oral Sciences, Faculty of Dentistry, The University of Hong Kong, Hong Kong SAR, China
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17
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Calabrese E, Kucharzik T, Maaser C, Maconi G, Strobel D, Wilson SR, Zorzi F, Novak KL, Bruining DH, Iacucci M, Watanabe M, Lolli E, Chiaramonte C, Hanauer SB, Panaccione R, Pallone F, Ghosh S, Monteleone G. Real-time Interobserver Agreement in Bowel Ultrasonography for Diagnostic Assessment in Patients With Crohn's Disease: An International Multicenter Study. Inflamm Bowel Dis 2018; 24:2001-2006. [PMID: 29718450 DOI: 10.1093/ibd/izy091] [Citation(s) in RCA: 36] [Impact Index Per Article: 6.0] [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] [Received: 08/23/2017] [Indexed: 12/27/2022]
Abstract
BACKGROUND The unavailability of standardized parameters in bowel ultrasonography (US) commonly used in Crohn's disease (CD) and the shortage of skilled ultrasonographers are 2 limiting factors in the use of this imaging modality around the world. The aim of this study is to evaluate interobserver agreement among experienced sonographers in the evaluation of bowel US parameters in order to improve standardization in imaging reporting and interpretation. METHODS Fifteen patients with an established diagnosis of CD underwent blinded bowel US performed by 6 experienced sonographers. Prior to the evaluation, the sonographers and clinical and radiological IBD experts met to formally define the US parameters. Interobserver agreement was tested with the Quatto method (s). RESULTS All operators agreed on the presence/absence of CD lesions and distinguished absence of/mild activity or moderate/severe lesions in all patients. S values were moderate for bowel wall thickness (s = 0.48, P = n.s.), bowel wall pattern (s = 0.41, P = n.s.), vascularization (s = 0.52, P = n.s.), and presence of lymphnodes (s = 0.61, P = n.s.). Agreement was substantial for lesion location (s = 0.68, P = n.s.), fistula (s = 0.74, P = n.s.), phlegmon (s = 0.78, P = 0.04), and was almost perfect for abscess (s = 0.95, P = 0.02). Poor agreement was observed for mesenteric adipose tissue alteration, lesion extent, stenosis, and prestenotic dilation. CONCLUSIONS In this study, the majority of the US parameters used in CD showed moderate/substantial agreement. The development of shared US imaging interpretation patterns among sonographers will lead to improved comparability of US results among centers and facilitate the development of multicenter studies and the spread of bowel US training, thereby allowing a wider adoption of this useful technique.
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Affiliation(s)
- Emma Calabrese
- Gastroenterology Unit, Department of Systems Medicine, University of Rome "Tor Vergata," Italy
| | - Torsten Kucharzik
- Department of Internal Medicine and Gastroenterology, Staedtisches Klinikum Lueneburg, Lueneburg, Germany
| | - Christian Maaser
- Ambulanzzentrum Gastroenterologie am Klinikum Lüneburg, Lüneburg, Germany
| | - Giovanni Maconi
- Department of Clinical Sciences, L. Sacco University Hospital, Milan, Italy
| | | | - Stephanie R Wilson
- Department of Radiology and **Division of Gastroenterology, Department of Medicine, University of Calgary, Calgary, Canada.,Division of Gastroenterology and Hepatology, Mayo Clinic College of Medicine, Rochester, Minnesota, USA
| | - Francesca Zorzi
- Gastroenterology Unit, Department of Systems Medicine, University of Rome "Tor Vergata," Italy
| | - Kerri L Novak
- Division of Gastroenterology and Hepatology, Mayo Clinic College of Medicine, Rochester, Minnesota, USA
| | - David H Bruining
- Department of Gastroenterology and Hepatology, Tokyo Medical and Dental University, Japan
| | - Marietta Iacucci
- Institute of Translational of Medicine, University of Birmingham, Birmingham, UK
| | - Mamoru Watanabe
- Northwestern University Feinberg School of Medicine, Digestive Disease Center, Chicago, Illinois, USA
| | - Elisabetta Lolli
- Gastroenterology Unit, Department of Systems Medicine, University of Rome "Tor Vergata," Italy
| | - Carlo Chiaramonte
- Gastroenterology Unit, Department of Systems Medicine, University of Rome "Tor Vergata," Italy
| | - Stephen B Hanauer
- Northwestern University Feinberg School of Medicine, Digestive Disease Center, Chicago, Illinois, USA
| | - Remo Panaccione
- Division of Gastroenterology and Hepatology, Mayo Clinic College of Medicine, Rochester, Minnesota, USA
| | - Francesco Pallone
- Gastroenterology Unit, Department of Systems Medicine, University of Rome "Tor Vergata," Italy
| | - Subrata Ghosh
- Institute of Translational of Medicine, University of Birmingham, Birmingham, UK
| | - Giovanni Monteleone
- Gastroenterology Unit, Department of Systems Medicine, University of Rome "Tor Vergata," Italy
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18
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Tripathi D, Sunderraj L, Vemala V, Mehrzad H, Zia Z, Mangat K, West R, Chen F, Elias E, Olliff SP. Long-term outcomes following percutaneous hepatic vein recanalization for Budd-Chiari syndrome. Liver Int 2017; 37:111-120. [PMID: 27254473 DOI: 10.1111/liv.13180] [Citation(s) in RCA: 39] [Impact Index Per Article: 5.6] [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] [Received: 01/24/2016] [Accepted: 05/31/2016] [Indexed: 12/26/2022]
Abstract
BACKGROUND & AIMS A proportion of patients with Budd-Chiari Syndrome (BCS) associated with stenosis or short occlusion of the hepatic vein (HV) or upper inferior vena cava (IVC) can be treated with recanalization by percutaneous venoplasty ± HV stent insertion. We studied the long-term outcomes of this approach. METHODS Single-centre retrospective analysis of patients referred for radiological assessment ± intervention over a 27-year period. Of 155 BCS patients, 63 patients who underwent venoplasty were studied and compared to a previously reported series treated by TIPSS (n = 59). RESULTS Patients treated with HV interventions (32 venoplasty alone, 31 endovascular stents): mean age, 34.9 ± 10.9; M:F ratio 27:36; median follow-up, 113.0 months; 62% of patients had ≥1 haematological risk factor. Technical success was 100%, with symptom resolution in 73%. Cumulative secondary patency at 1, 5, 10 years was 92%, 79%, 79% and 69%, 69%, 64% in the stenting and venoplasty groups respectively. Where long-term patency was not achieved, 10 patients required TIPSS, and 8 underwent surgery. Actuarial survival at 1, 5, 10 years was 97%, 89% and 85%. When compared to TIPSS, HV interventions resulted in similar patency and survival rates but significantly lower procedural complications (9.5% vs 27.1%) and hepatic encephalopathy (0% vs 18%). Patient age predicted survival following multivariate analysis. CONCLUSIONS Our data support the stepwise approach to management of BCS, with very good outcomes from venoplasty combined with stenting when required. TIPSS should only be offered where HV interventions are not feasible or unsuccessful.
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Affiliation(s)
| | | | | | - Homoyon Mehrzad
- Imaging and Interventional Radiology Dept, Queen Elizabeth Hospital, Birmingham, UK
| | - Zergham Zia
- Imaging and Interventional Radiology Dept, Queen Elizabeth Hospital, Birmingham, UK
| | - Kamarjit Mangat
- Imaging and Interventional Radiology Dept, Queen Elizabeth Hospital, Birmingham, UK.,Department of Radiology, National University Hospital, Singapore
| | - Richard West
- Imaging and Interventional Radiology Dept, Queen Elizabeth Hospital, Birmingham, UK
| | - Frederick Chen
- Department of Haematology, Queen Elizabeth Hospital, Birmingham, UK
| | - Elwyn Elias
- Liver Unit, Queen Elizabeth Hospital, Birmingham, UK
| | - Simon P Olliff
- Imaging and Interventional Radiology Dept, Queen Elizabeth Hospital, Birmingham, UK
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19
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Canavan C, Eisenburg J, Meng L, Corey K, Hur C. Ultrasound elastography for fibrosis surveillance is cost effective in patients with chronic hepatitis C virus in the UK. Dig Dis Sci 2013; 58:2691-704. [PMID: 23720196 PMCID: PMC4067701 DOI: 10.1007/s10620-013-2705-y] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2013] [Accepted: 04/24/2013] [Indexed: 02/06/2023]
Abstract
BACKGROUND Chronic hepatitis C (HCV) is a significant risk factor for cirrhosis and subsequently hepatocellular carcinoma (HCC). HCV patients with cirrhosis are screened for HCC every 6 months. Surveillance for progression to cirrhosis and consequently access to HCC screening is not standardized. Liver biopsy, the usual test to determine cirrhosis, carries a significant risk of morbidity and associated mortality. Transient ultrasound elastography (fibroscan) is a non-invasive test for cirrhosis. PURPOSE This study assesses the cost effectiveness of annual surveillance for cirrhosis in patients with chronic HCV and the effect of replacing biopsy with fibroscan to diagnose cirrhosis. METHOD A Markov decision analytic model simulated a hypothetical cohort of 10,000 patients with chronic HCV initially without fibrosis over their lifetime. The cirrhosis surveillance strategies assessed were: no surveillance; current practice; fibroscan in current practice with biopsy to confirm cirrhosis; fibroscan completely replacing biopsy in current practice (definitive); annual biopsy; annual fibroscan with biopsy to confirm cirrhosis; annual definitive fibroscan. RESULTS Our results demonstrate that annual definitive fibroscan is the optimal strategy to diagnose cirrhosis. In our study, it diagnosed 20 % more cirrhosis cases than the current strategy, with 549 extra patients per 10,000 accessing screening over a lifetime and, consequently, 76 additional HCC cases diagnosed. The lifetime cost is £98.78 extra per patient compared to the current strategy for 1.72 additional unadjusted life years. Annual fibroscan surveillance of 132 patients results in the diagnosis one additional HCC case over a lifetime. The incremental cost-effectiveness ratio for an annual definitive fibroscan is £6,557.06/quality-adjusted life years gained. CONCLUSION Annual definitive fibroscan may be a cost-effective surveillance strategy to identify cirrhosis in patients with chronic HCV, thereby allowing access of these patients to HCC screening.
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Affiliation(s)
- C Canavan
- Division of Epidemiology and Public Health, Nottingham University, Clinical Sciences Building, City Hospital Campus, Hucknall Road, Nottingham, NG5 1PB, UK.
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