1
|
Chung M, Ton L, Lee AY. Forget Me Not: Incidental Findings on Breast MRI. J Breast Imaging 2024:wbae023. [PMID: 38758984 DOI: 10.1093/jbi/wbae023] [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: 09/02/2023] [Indexed: 05/19/2024]
Abstract
With the growing utilization and expanding role of breast MRI, breast imaging radiologists may encounter an increasing number of incidental findings beyond the breast and axilla. Breast MRI encompasses a large area of anatomic coverage extending from the lower neck to the upper abdomen. While most incidental findings on breast MRI are benign, identifying metastatic disease can have a substantial impact on staging, prognosis, and treatment. Breast imaging radiologists should be familiar with common sites, MRI features, and breast cancer subtypes associated with metastatic disease to assist in differentiating malignant from benign findings. Furthermore, detection of malignancies of nonbreast origin as well as nonmalignant, but clinically relevant, incidental findings can significantly impact clinical management and patient outcomes. Breast imaging radiologists should consistently follow a comprehensive search pattern and employ techniques to improve the detection of these important incidental findings.
Collapse
Affiliation(s)
- Maggie Chung
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, CA, USA
| | - Lauren Ton
- School of Medicine, University of California, San Francisco, CA, USA
| | - Amie Y Lee
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, CA, USA
| |
Collapse
|
2
|
Chang CC, Saifee M, Ton L, Ashraf D, Winn BJ, Kersten R, Vagefi MR, Deiner M, Grob SR. Eye Trauma in Mixed Martial Arts and Boxing. Ophthalmic Plast Reconstr Surg 2024; 40:75-87. [PMID: 37656909 PMCID: PMC10926996 DOI: 10.1097/iop.0000000000002510] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/03/2023]
Abstract
PURPOSE To evaluate and compare eye and face trauma in mixed martial arts (MMA) and boxing. DESIGN Retrospective cohort study. METHODS Data from boxing and MMA competitions were extracted from the Nevada Athletic Commission (NAC) between 2000 and 2020. Details of competitions, contestants, outcomes, and injuries were extracted. RESULTS In total 1539 boxing injuries (from 4313 contests) and 1442 MMA injuries (from 2704 contests) were identified. Boxing had higher eye injury rates compared to MMA ( p < 0.0001), with an odds ratio of 1.268 (95% CI, 1.114-1.444). Eye trauma represented 47.63% of boxing injuries and 25.59% of MMA injuries, with periocular lacerations being the most common eye injury in both. Orbital fractures represented 17.62% of eye injuries in MMA and 3.14% in boxing contests. However, 2%-3% were retinal in both sports, and 3.27% were glaucomatous in boxing. MMA contestants had an odds ratio of 1.823 (95% CI, 1.408-2.359) for requiring physician evaluation following an eye injury compared with boxing. MMA contestants also had a higher rate of face ( p < 0.0001) and body ( p < 0.0001) injuries. For both sports, an increased number of rounds and being the losing fighter were associated with increased odds of eye and face injury. CONCLUSION Although boxing has a higher rate of eye injuries, MMA eye injuries are more likely to require physician evaluation. MMA contestants also have a higher rate of orbital fractures and face and body trauma. A detailed postfight examination and long-term follow-up of ocular injury in combat sports will be vital in proposing reforms to prevent eye trauma.
Collapse
Affiliation(s)
- Chih-Chiun Chang
- University of California, San Francisco School of Medicine, San Francisco, California, U.S.A
| | - Murtaza Saifee
- Department of Ophthalmology, University of California, San Francisco School of Medicine, San Francisco, California, U.S.A
| | - Lauren Ton
- University of California, San Francisco School of Medicine, San Francisco, California, U.S.A
| | - Davin Ashraf
- Orbit and Oculofacial Plastic Surgery, Department of Ophthalmology, Oregon Health & Sciences University, Portland, Oregon, U.S.A
| | - Bryan J Winn
- Department of Ophthalmology, University of California, San Francisco School of Medicine, San Francisco, California, U.S.A
- Orbit and Oculofacial Plastic Surgery, Department of Ophthalmology, University of California, San Francisco, San Francisco, California, U.S.A
| | - Robert Kersten
- Department of Ophthalmology, University of California, San Francisco School of Medicine, San Francisco, California, U.S.A
- Orbit and Oculofacial Plastic Surgery, Department of Ophthalmology, University of California, San Francisco, San Francisco, California, U.S.A
| | - M Reza Vagefi
- Department of Ophthalmology, University of California, San Francisco School of Medicine, San Francisco, California, U.S.A
- Orbit and Oculofacial Plastic Surgery, Department of Ophthalmology, University of California, San Francisco, San Francisco, California, U.S.A
| | - Michael Deiner
- Department of Ophthalmology, University of California, San Francisco School of Medicine, San Francisco, California, U.S.A
- F.I. Proctor Foundation, University of California, San Francisco School of Medicine, San Francisco, California, U.S.A
| | - Seanna R Grob
- Department of Ophthalmology, University of California, San Francisco School of Medicine, San Francisco, California, U.S.A
- Orbit and Oculofacial Plastic Surgery, Department of Ophthalmology, University of California, San Francisco, San Francisco, California, U.S.A
| |
Collapse
|
3
|
Ton L, Zhang W, Saifee M, Walia A, Oatts J, Han Y. Severe proptosis during cataract surgery. Am J Ophthalmol Case Rep 2023; 32:101901. [PMID: 37554298 PMCID: PMC10405188 DOI: 10.1016/j.ajoc.2023.101901] [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: 02/15/2023] [Revised: 06/14/2023] [Accepted: 07/19/2023] [Indexed: 08/10/2023] Open
Abstract
PURPOSE We report an unusual case of severe proptosis during phacoemulsification in a 58-year-old female with a history of Crohn's disease, bilateral chronic panuveitis, prior bilateral central retinal vein occlusion, and uncontrolled steroid-associated ocular hypertension requiring bilateral Ahmed glaucoma drainage device (GDD) implantation with pars plana tube placement. OBSERVATIONS During phacoemulsification of the right eye, the patient developed significant proptosis. Following lid speculum removal and mechanical eyelid manipulation, the proptosis resolved within 20 minutes without requiring a lateral canthotomy. The patient had no permanent visual complications. CONCLUSIONS AND IMPORTANCE The likely pathophysiology of intraoperative proptosis in this case was accumulation of fluid in the retrobulbar space due to a functioning Ahmed tube shunt with the tube placed in the vitreous cavity. To avoid this complication, concurrent cataract surgery may be considered for patients with pars plana tube placement GDD surgery.
Collapse
Affiliation(s)
- Lauren Ton
- School of Medicine, University of California San Francisco, San Francisco, CA, USA
| | - Wanlin Zhang
- University of California Berkeley, Berkeley, CA, USA
| | - Murtaza Saifee
- Department of Ophthalmology, University of California San Francisco, San Francisco, CA, USA
| | - Anushka Walia
- School of Medicine, University of California San Francisco, San Francisco, CA, USA
| | - Julius Oatts
- Department of Ophthalmology, University of California San Francisco, San Francisco, CA, USA
| | - Ying Han
- Department of Ophthalmology, University of California San Francisco, San Francisco, CA, USA
| |
Collapse
|
4
|
Ton L, Chung M. Updated Recommendations by the American College of Radiology for Breast Cancer Screening in Individuals at Higher-Than-Average Risk. Radiol Imaging Cancer 2023; 5:e239015. [PMID: 37505104 PMCID: PMC10413292 DOI: 10.1148/rycan.239015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/29/2023]
|
5
|
Yonamine S, Ton L, Rose-Nussbaumer J, Ying GS, Ahmed IIK, Chen TC, Weiner A, Gedde SJ, Han Y. Survey of the American Glaucoma Society Membership on Current Glaucoma Drainage Device Placement and Postoperative Corticosteroid Use. Clin Ophthalmol 2022; 16:2305-2310. [PMID: 35903751 PMCID: PMC9317359 DOI: 10.2147/opth.s369673] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2022] [Accepted: 07/05/2022] [Indexed: 11/23/2022] Open
Abstract
Purpose To assess practice patterns and opinions of glaucoma specialists regarding glaucoma drainage device tube shunt placement and post-operative anti-inflammatory medication use. We also assess the perceived need for a randomized control trial to compare them. Patients and Methods An online survey was distributed to a group of glaucoma specialists from the American Glaucoma Society via the American Glaucoma Society forum from April to August 2021. Results One hundred and twenty-eight responses were included. Ninety percent placed tubes in the anterior chamber. Sixty-one percent reported that evidence suggested the superiority of sulcus tube placement over the anterior chamber, whereas 34% reported there was not enough evidence to suggest superiority of either in preventing endothelial cell loss. Comparing these techniques for intraocular pressure control, 49% reported evidence suggested sulcus tube placement superiority whereas 46% reported there was not enough evidence. Over 40% of respondents reported that they were either unfamiliar with literature or that there was not enough evidence to support the superiority of difluprednate 0.05% over prednisolone 1% for post-operative use in preventing endothelial cell loss and for intraocular pressure control. Ninety percent and 81% of respondents respectively would benefit from randomized control trials comparing outcomes of anterior chamber vs sulcus tube placement and post-operative corticosteroid usage. Conclusion Most glaucoma specialists surveyed place glaucoma drainage device tube in the anterior chamber over the sulcus. A randomized control trial to determine optimal tube placement and post-operative anti-inflammatory medication use for preventing endothelial cell loss would change current glaucoma drainage device practice patterns.
Collapse
Affiliation(s)
- Sean Yonamine
- Department of Ophthalmology, University of California San Francisco, San Francisco, CA, USA
| | - Lauren Ton
- School of Medicine, University of California San Francisco, San Francisco, CA, USA
| | | | - Gui-Shuang Ying
- Center for Preventive Ophthalmology and Biostatistics, Department of Ophthalmology, University of Pennsylvania, Philadelphia, PA, USA
| | | | - Teresa C Chen
- Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, MA, USA
| | - Asher Weiner
- University at Buffalo, State University of New York, Buffalo, NY, USA
| | - Steven J Gedde
- Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Ying Han
- Department of Ophthalmology, University of California San Francisco, San Francisco, CA, USA
- Correspondence: Ying Han, Department of Ophthalmology, University of California San Francisco, San Francisco, CA, USA, Tel +1 415 514 6920, Fax +1 415 353 4250, Email
| |
Collapse
|
6
|
Alsoudi AF, Ton L, Ashraf DC, Idowu OO, Kong AW, Wang L, Kersten RC, Winn BJ, Grob SR, Reza Vagefi M. Efficacy of Care and Antibiotic Use for Chalazia and Hordeola. Eye Contact Lens 2022; 48:162-168. [PMID: 35296627 PMCID: PMC8931268 DOI: 10.1097/icl.0000000000000859] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/17/2021] [Indexed: 11/25/2022]
Abstract
OBJECTIVES To evaluate whether use of an antibiotic improves the efficacy of care for a chalazion or hordeolum. METHODS A cross-sectional retrospective review was performed. All patients treated for a newly diagnosed chalazion or hordeolum at the University of California, San Francisco from 2012 to 2018 were identified. Patients were excluded when clinical notes were inaccessible or there was inadequate documentation of treatment modality or outcome. Patient demographics, setting of initial presentation, treatment modalities, antibiotic use, and outcomes were analyzed. RESULTS A total of 2,712 patients met inclusion criteria. Management with an antibiotic was observed in 36.5% of patients. An antibiotic was 1.53 times (95% confidence interval [CI], 1.06-2.22, P=0.025) more likely to be prescribed in emergency or acute care setting for a chalazion. Older age was associated with a higher risk of receiving an antibiotic for a hordeolum (adjusted RR 1.07 per decade, 95% CI, 1.05-1.11, P<0.001). The addition of an antibiotic to conservative measures for a chalazion (adjusted RR, 0.97, 95% CI, 0.89-1.04, P=0.393) or hordeolum (adjusted RR, 0.99, 95% CI, 0.96-1.02, P=0.489) was not associated with an increased likelihood of treatment success. CONCLUSION Although frequently prescribed, an antibiotic is unlikely to improve the resolution of a chalazion or hordeolum.
Collapse
Affiliation(s)
- Amer F. Alsoudi
- School of Medicine, University of California San Francisco, San Francisco, CA
| | - Lauren Ton
- School of Medicine, University of California San Francisco, San Francisco, CA
| | - Davin C. Ashraf
- Department of Ophthalmology, University of California San Francisco, San Francisco, CA
| | - Oluwatobi O. Idowu
- Department of Ophthalmology, University of California San Francisco, San Francisco, CA
| | - Alan W. Kong
- School of Medicine, University of California San Francisco, San Francisco, CA
| | - Linyan Wang
- Department of Ophthalmology, University of California San Francisco, San Francisco, CA
| | - Robert C. Kersten
- Department of Ophthalmology, University of California San Francisco, San Francisco, CA
| | - Bryan J. Winn
- Department of Ophthalmology, University of California San Francisco, San Francisco, CA
| | - Seanna R. Grob
- Department of Ophthalmology, University of California San Francisco, San Francisco, CA
| | - M. Reza Vagefi
- Department of Ophthalmology, University of California San Francisco, San Francisco, CA
| |
Collapse
|
7
|
Kirzner N, Etherington G, Ton L, Chan P, Paul E, Liew S, Humadi A. Relationship between facet joint distraction during anterior cervical discectomy and fusion for trauma and functional outcome. Bone Joint J 2018; 100-B:1201-1207. [DOI: 10.1302/0301-620x.100b9.bjj-2018-0199.r1] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Aims The purpose of this retrospective study was to investigate the clinical relevance of increased facet joint distraction as a result of anterior cervical decompression and fusion (ACDF) for trauma. Patients and Methods A total of 155 patients (130 men, 25 women. Mean age 42.7 years; 16 to 87) who had undergone ACDF between 1 January 2001 and 1 January 2016 were included in the study. Outcome measures included the Neck Disability Index (NDI) and visual analogue scale (VAS) for pain. Lateral cervical spine radiographs taken in the immediate postoperative period were reviewed to compare the interfacet distance of the operated segment with those of the facet joints above and below. Results There was a statistically significant relationship between greater facet distraction and increased NDI and VAS pain scores. This was further confirmed by Spearman correlation, which showed evidence of a moderate correlation between both NDI score and facet joint distraction (Spearman correlation coefficient 0.34; p < 0.001) and VAS score and facet distraction (Spearman correlation coefficient 0.52; p < 0.001). Furthermore, there was a discernible transition point between outcome scores. Significantly worse outcomes, in terms of both NDI scores (17.8 vs 8.2; p < 0.001) and VAS scores (4.5 vs 1.3; p < 0.001), were seen with facet distraction of 3 mm or more. Patients who went on to have a posterior fusion also had increased NDI and VAS scores, independent of facet distraction. Conclusion After undergoing ACDF for the treatment of cervical spine injury, patients with facet joint distraction of 3 mm or more have worse NDI and VAS pain scores. Cite this article: Bone Joint J 2018;100-B:1201–7.
Collapse
Affiliation(s)
| | | | - L. Ton
- Alfred Hospital, Prahran, Australia
| | - P. Chan
- Alfred Hospital, Prahran, Australia
| | - E. Paul
- Alfred Hospital, Prahran, Australia
| | - S. Liew
- Alfred Hospital, Prahran, Australia
| | | |
Collapse
|
8
|
Yap JE, Jaiswal P, Ton L, Szynkarek R, Attar BM, Gandhi S. Successful treatment of chronic hepatitis C infection with crushed elbasvir/grazoprevir administered via a percutaneous endoscopic gastrostomy tube. J Clin Pharm Ther 2018; 43:730-732. [DOI: 10.1111/jcpt.12713] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2018] [Accepted: 04/24/2018] [Indexed: 12/22/2022]
Affiliation(s)
- J. E. Yap
- Division of Gastroenterology and HepatologyCook County Health and Hospitals System Chicago IL USA
| | - P. Jaiswal
- Department of Internal MedicineCook County Health and Hospitals System Chicago IL USA
| | - L. Ton
- Division of Gastroenterology and HepatologyCook County Health and Hospitals System Chicago IL USA
| | - R. Szynkarek
- Department of PharmacyCook County Health and Hospital System Chicago IL USA
| | - B. M. Attar
- Division of Gastroenterology and HepatologyCook County Health and Hospitals System Chicago IL USA
| | - S. Gandhi
- Division of Gastroenterology and HepatologyCook County Health and Hospitals System Chicago IL USA
| |
Collapse
|
9
|
Ong D, Ton L. Interdisciplinary management of an adolescent patient with significant previous trauma to the upper incisors. Aust Dent J 2015; 60:260-9. [PMID: 25988426 DOI: 10.1111/adj.12328] [Citation(s) in RCA: 3] [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] [Accepted: 08/12/2014] [Indexed: 11/27/2022]
Abstract
Significant dental trauma may result in short-term and long-term clinical dilemmas. There are many factors to consider when formulating the relevant and reasonable treatment options for such patients. Interdisciplinary management has the potential to significantly improve both aesthetic and functional outcomes in challenging cases. With respect to each presented option, the patient must be informed of the inherent advantages and disadvantages, the appropriate treatment timing, duration and the costs involved, both financial and biological.
Collapse
Affiliation(s)
- D Ong
- Orthodontic Department, School of Dentistry, The University of Queensland.,Private Practice, Townsville, Queensland
| | - L Ton
- Private Practice, Townsville, Queensland
| |
Collapse
|
10
|
Spina CS, Ton L, Yao M, Maehr H, Wolfe MM, Uskokovic M, Adorini L, Holick MF. Selective vitamin D receptor modulators and their effects on colorectal tumor growth. J Steroid Biochem Mol Biol 2007; 103:757-62. [PMID: 17368190 DOI: 10.1016/j.jsbmb.2006.12.040] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
The active form of vitamin D, 1,25-dihydroxyvitamin D(3) [1,25(OH)(2)D(3)], is an endocrine hormone whose classic role is the maintenance of calcium homeostasis. It is well documented that 1,25(OH)(2)D(3) also has anti-tumor effects on a number of cancers and cancer cell lines including breast, colorectal, gastric, liver, ovarian, prostate, and non-melanoma skin cancers. Included in the anti-tumor activities of 1,25(OH)(2)D(3) are its ability to cause antiproliferation, prodifferentation and decrease angiogenesis. Furthermore, through regulation of the plaminogen activator (PA) system and a class of proteolytic enzymes called matrix metalloproteinases (MMPs), 1,25(OH)(2)D(3) reduces the invasive spread of tumor cells. Because of the calcemic limitations of using 1,25(OH)(2)D(3) as a therapy, we have tested the effects of a novel Gemini vitamin D analogue, Deuterated Gemini (DG), on mouse colorectal cancer. We demonstrated that DG is more potent in reducing tumor volume and mass, compared to control and 1,25(OH)(2)D(3). DG significantly prevented (100% reduction, p<0.05) the invasive spread of colorectal tumor cells into the surrounding muscle, and had no effect on serum calcium levels. Thus, DG acts as a selective vitamin D receptor modulator (SVDRM) by enhancing select anti-tumor characteristic 1,25(OH)(2)D(3) activities, without inducing hypercalcemia. Thus, DG shows promise in the development of colorectal cancer therapies.
Collapse
Affiliation(s)
- C S Spina
- Vitamin D, Skin and Bone Research Laboratories, Endocrine Section, Department of Medicine, Physiology and Biophysics, Boston University Medical Center, 715 Albany Street, M-1013, Boston, MA 02118, USA.
| | | | | | | | | | | | | | | |
Collapse
|
11
|
Abstract
Late radiation injury is the main dose-limiting factor for radiotherapy of tumors of the central nervous system (CNS). Clinical experience as well as analyses of complication data, both for brain necrosis and for changes in neuroimaging after radiosurgery, suggest a pronounced volume effect in the brain. However, the relationships of dose and volume to complications after irradiation of lesions in the brain have yet to be quantitatively assessed. The quantification of volume effects and the modeling of normal tissue response to partial organ irradiation of the brain are particularly demanding because of the highly differentiated and complex structure of the brain and the variety of endpoints after radiotherapy for CNS diseases. This article summarizes the existing clinical data that demonstrate a volume effect in the brain and the current state of knowledge regarding the modeling of complications following partial irradiation of the brain.
Collapse
Affiliation(s)
- S Levegrün
- Department of Medical Physics, Deutsches Krebsforschungszentrum (DKFZ), Im Neuenheimer Feld 280 D-69120 Heidelberg, Germany.
| | | | | |
Collapse
|
12
|
Collins FH, Saunders RD, Kafatos FC, Roth C, Ke Z, Wang X, Dymbrowski K, Ton L, Hogan J. Genetics in the study of mosquito susceptibility to Plasmodium. Parassitologia 1999; 41:163-8. [PMID: 10697850] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Indexed: 02/15/2023]
Abstract
Within the past several years, a number of powerful genetic and genomic tools have been developed for use in research on the African malaria vector Anopheles gambiae. While these tools have been developed with a broad range of potential applications in mind, they have been particularly useful in advancing the effort to clone a set of An. gambiae genes that enable a refractory strain of this mosquito to encapsulate and kill a wide variety of different malaria parasites to which this mosquito is normally fully susceptible. This paper describes the latest progress in this map-based cloning research, which involves the collaborative contributions of a number of different laboratories in Europe and the United States.
Collapse
Affiliation(s)
- F H Collins
- Department of Biological Sciences, University of Notre Dame, IN 46556, USA.
| | | | | | | | | | | | | | | | | |
Collapse
|