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Kwapong YA, Sharma G, Valero-Elizondo J, Achirica MC, Ali SS, Blaha MJ, Blankstein R, Shapiro MD, Arias L, Budoff MJ, Feldman T, Cury RC, Mehta L, Fialkow J, Nasir K. The association of sex-specific hormones with coronary artery plaque characteristics from Miami Heart (MiHeart) study. Am J Prev Cardiol 2023; 14:100479. [PMID: 36950675 PMCID: PMC10025130 DOI: 10.1016/j.ajpc.2023.100479] [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: 11/15/2022] [Revised: 02/01/2023] [Accepted: 02/25/2023] [Indexed: 03/06/2023] Open
Abstract
Objective The association of sex-specific hormones with coronary computed tomography angiography(CCTA)-based plaque characteristics in women without cardiovascular disease is not well understood. We investigated the association of sex-specific hormones with coronary artery plaque characteristics in a contemporary multiracial cohort with no clinical coronary artery disease (CAD). Methods In this cross-sectional analysis, we utilized data from 2,325 individuals with no clinical CAD from the Miami Heart (MiHeart) study. Multivariable logistic regression models were used to investigate the association of sex hormones: sex hormone binding globulin (SHBG), dehydroepiandrosterone (DHEA), free and total testosterone, estradiol, with plaque characteristics among women and men. Results Of the 1,155 women, 34.2% had any plaque and 3.4% had any high-risk plaque features (HRP) while among men (n = 1170), 63.1% had any plaque and 10.4% had HRP. Among women, estradiol and SHBG were associated with lower odds of any plaque after adjusting for age and race-ethnicity (estradiol OR per SD increase: 0.87, 95%CI: 0.76-0.98; SHBG OR per SD increase: 0.82, 95%CI: 0.72-0.93) but the significance did not persist after adjustment of cardiovascular risk factors. High free testosterone was associated with higher odds of HRP (aOR:3.48, 95%CI:1.07-11.26) but null associations for the other sex hormones with HRP, in the context of limited sample size. Among men, there were no significant associations between sex-specific hormones and plaque or HRP. Conclusion Among young to middle-aged women with no clinical CAD, increasing estradiol and SHBG were associated with lower odds of any plaque and higher free testosterone was associated with HRP. Larger cohorts may be needed to validate this.
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Affiliation(s)
- Yaa A. Kwapong
- Johns Hopkins Ciccarone Center for the Prevention of Cardiovascular Diseases, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Garima Sharma
- Johns Hopkins Ciccarone Center for the Prevention of Cardiovascular Diseases, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Javier Valero-Elizondo
- Division of Cardiovascular Prevention and Wellness, Department of Cardiology, Houston Methodist DeBakey Heart & Vascular Center, Houston, TX, USA
- Center for Outcomes Research, Houston Methodist, Houston, TX, USA
| | - Miguel Cainzos Achirica
- Johns Hopkins Ciccarone Center for the Prevention of Cardiovascular Diseases, Johns Hopkins School of Medicine, Baltimore, MD, USA
- Division of Cardiovascular Prevention and Wellness, Department of Cardiology, Houston Methodist DeBakey Heart & Vascular Center, Houston, TX, USA
- Center for Outcomes Research, Houston Methodist, Houston, TX, USA
| | - Shozab S. Ali
- Miami Cardiac and Vascular Institute, Baptist Health South Florida, Miami, FL, USA
- Herbert Wertheim College of Medicine, Florida International University, Miami, FL, USA
| | - Michael J. Blaha
- Johns Hopkins Ciccarone Center for the Prevention of Cardiovascular Diseases, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Ron Blankstein
- Brigham and Women's Hospital Heart and Vascular Center, and Harvard Medical School, Boston, MA, USA
| | - Michael D. Shapiro
- Center for Prevention of Cardiovascular Disease, Section on Cardiovascular Medicine, Wake Forest University School of Medicine, Winston-Salem, NC, USA
| | - Lara Arias
- Center for Outcomes Research, Houston Methodist, Houston, TX, USA
| | - Matthew J. Budoff
- Division of Cardiology, Harbor UCLA Medical Center, Torrance, CA, USA
- The Lundquist Institute, Harbor UCLA, Medical Center, Torrance, CA, USA
| | - Theodore Feldman
- Miami Cardiac and Vascular Institute, Baptist Health South Florida, Miami, FL, USA
- Herbert Wertheim College of Medicine, Florida International University, Miami, FL, USA
| | - Ricardo C. Cury
- Miami Cardiac and Vascular Institute, Baptist Health South Florida, Miami, FL, USA
- Herbert Wertheim College of Medicine, Florida International University, Miami, FL, USA
| | - Laxmi Mehta
- Division of Cardiology, the Ohio State University School of Medicine, Columbus, OH, USA
| | - Jonathan Fialkow
- Miami Cardiac and Vascular Institute, Baptist Health South Florida, Miami, FL, USA
| | - Khurram Nasir
- Johns Hopkins Ciccarone Center for the Prevention of Cardiovascular Diseases, Johns Hopkins School of Medicine, Baltimore, MD, USA
- Division of Cardiovascular Prevention and Wellness, Department of Cardiology, Houston Methodist DeBakey Heart & Vascular Center, Houston, TX, USA
- Center for Outcomes Research, Houston Methodist, Houston, TX, USA
- Corresponding author at: Division of Cardiovascular Prevention and Wellness, Department of Cardiology, Houston Methodist DeBakey Heart & Vascular Center, 6550 Fannin St Suite 1801, Houston, TX 77030, USA.
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Dong B, Chen R, Zhu X, Wu Q, Jin J, Wang W, Zhu Y, Jiang H, Bi N, Wang X, Xu X, Xu Y, Chen M. Comparison of stereotactic body radiation therapy versus surgery for multiple primary lung cancers after prior radical resection: A multicenter retrospective study. Clin Transl Radiat Oncol 2023; 40:100601. [PMID: 36936471 PMCID: PMC10020093 DOI: 10.1016/j.ctro.2023.100601] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [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: 12/06/2022] [Revised: 01/26/2023] [Accepted: 02/13/2023] [Indexed: 02/17/2023] Open
Abstract
Background Patients who previously underwent surgical resection of initial primary lung cancer are at a high risk of developing multiple primary lung cancers (MPLCs). The purpose of this study was to compare the efficacy and safety between stereotactic body radiation therapy (SBRT) and surgery for MPLCs patients after prior radical resection for the first lung cancers. Methods In this multicenter retrospective study, eligible MPLC patients with tumor diameter of 5.0 cm or less at N0M0 who underwent SBRT or reoperation between January 2013 and August 2020 were enrolled. The primary endpoint was the 3-year locoregional recurrence and treatment-related toxicity. Kaplan-Meier method was used to calculate survival rates. The χ2 test was adapted to assess the difference of categorical variables between the two subgroup patients. Results A total of 203 (73 in the SBRT group and 130 in the surgery group) patients from three academic cancer centers were evaluated with a median follow-up of 38.3 months. The cumulative 1-, 2-, and 3-year incidences of locoregional recurrence were 5.6 %, 7.0 % and 13.1 % in the SBRT group versus 3.2 %, 4.8 % and 7.4 % in the surgery group, respectively [hazard ratio (HR), 1.97; 95 % confidence interval (CI), 0.74-5.24; P = 0.14]. The cancer-specific survival rates were 95.9 %, 94.5 % and 88.1 % versus 96.9 %, 94.6 % and 93.8 % in the SBRT and surgery groups respectively (HR, 1.72; 95 % CI, 0.67-4.44; P = 0.23). In the SBRT group, two patients (2.7 %) suffered from grade 3 radiation pneumonitis, while in the surgery group, grade 3 complications occurred in four (3.1 %) patients, and four cases were expired due to pneumonia or pulmonary heart disease within 90 days after surgery. Conclusions SBRT is an effective therapeutic option with limited toxicity compared to surgery for patients with MPLCs after prior radical surgical resection, and it could be considered as an alternative treatment for those patients.
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Key Words
- BED, biological effective dose
- CCI, Charlson comorbidity index
- CSS, cancer-specific survival
- CT, computed tomography
- DM, distant metastasis
- FEV1, forced expiratory volume in the first second
- FVC, forced vital capacity
- ITV, internal target volume
- KPS, Karnofsky performance status
- LRR, locoregional recurrence
- Locoregional recurrence
- MPLC, multiple primary lung cancer
- Multiple primary lung cancers
- NSCLC, non-small cell lung cancer
- OS, overall survival
- PET/CT, positron emission tomography/computed tomography
- PTV, planning target volume
- Radical resection
- SBRT, stereotactic body radiation therapy
- Stereotactic body radiation therapy
- TTP, time to progression
- Toxicity
- VATS, video-assisted thoracoscopic surgery
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Affiliation(s)
- Baiqiang Dong
- Department of Radiation Oncology, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University, Guangzhou, China
- Department of Thoracic Radiotherapy, The Cancer Hospital of the University of Chinese Academy of Sciences (Zhejiang Cancer Hospital), Institute of Basic Medicine and Cancer (IBMC), Chinese Academy of Sciences, Zhejiang Key Laboratory of Radiation Oncology, Hangzhou, China
| | - Runzhe Chen
- Department of Radiation Oncology, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University, Guangzhou, China
| | - Xuan Zhu
- Department of Radiation Oncology, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China
| | - Qing Wu
- Department of Thoracic Radiotherapy, The Cancer Hospital of the University of Chinese Academy of Sciences (Zhejiang Cancer Hospital), Institute of Basic Medicine and Cancer (IBMC), Chinese Academy of Sciences, Zhejiang Key Laboratory of Radiation Oncology, Hangzhou, China
- The Second Clinical Medical College of Zhejiang Chinese Medicine University, Hangzhou, China
| | - Jia'nan Jin
- Department of Thoracic Radiotherapy, The Cancer Hospital of the University of Chinese Academy of Sciences (Zhejiang Cancer Hospital), Institute of Basic Medicine and Cancer (IBMC), Chinese Academy of Sciences, Zhejiang Key Laboratory of Radiation Oncology, Hangzhou, China
| | - Wenqing Wang
- Department of Radiation Oncology, Cancer Hospital Chinese Academy of Medical Sciences, Beijing, China
| | - Yujia Zhu
- Department of Radiation Oncology, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University, Guangzhou, China
| | - Hui Jiang
- Department of Radiation Oncology, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University, Guangzhou, China
| | - Nan Bi
- Department of Radiation Oncology, Cancer Hospital Chinese Academy of Medical Sciences, Beijing, China
| | - Xu Wang
- Department of Radiology, The Cancer Hospital of the University of Chinese Academy of Sciences (Zhejiang Cancer Hospital), Institute of Basic Medicine and Cancer (IBMC), Chinese Academy of Sciences, Zhejiang Key Laboratory of Radiation Oncology, Hangzhou, China
| | - Xiaofang Xu
- Department of Thoracic Oncology Surgery, The Cancer Hospital of the University of Chinese Academy of Sciences (Zhejiang Cancer Hospital), Institute of Basic Medicine and Cancer (IBMC), Chinese Academy of Sciences, Zhejiang Key Laboratory of Radiation Oncology, Hangzhou, China
| | - Yujin Xu
- Department of Thoracic Radiotherapy, The Cancer Hospital of the University of Chinese Academy of Sciences (Zhejiang Cancer Hospital), Institute of Basic Medicine and Cancer (IBMC), Chinese Academy of Sciences, Zhejiang Key Laboratory of Radiation Oncology, Hangzhou, China
- Corresponding authors at: The Cancer Hospital of the University of Chinese Academy of Sciences (Zhejiang Cancer Hospital), No. 1, East Banshan Road, Hangzhou 310022, China (Y. Zu) and Sun Yat-sen University Cancer Center, 651 East Dongfeng Road, Guangzhou 510060, China (M. Chen).
| | - Ming Chen
- Department of Radiation Oncology, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University, Guangzhou, China
- Department of Thoracic Radiotherapy, The Cancer Hospital of the University of Chinese Academy of Sciences (Zhejiang Cancer Hospital), Institute of Basic Medicine and Cancer (IBMC), Chinese Academy of Sciences, Zhejiang Key Laboratory of Radiation Oncology, Hangzhou, China
- Corresponding authors at: The Cancer Hospital of the University of Chinese Academy of Sciences (Zhejiang Cancer Hospital), No. 1, East Banshan Road, Hangzhou 310022, China (Y. Zu) and Sun Yat-sen University Cancer Center, 651 East Dongfeng Road, Guangzhou 510060, China (M. Chen).
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Seidensticker M, Öcal O, Schütte K, Malfertheiner P, Berg T, Loewe C, Klümpen HJ, van Delden O, Ümütlü MR, Ben Khaled N, de Toni EN, Seidensticker R, Aghdassi A, Tran A, Bronowicki JP, Peynircioglu B, Sangro B, Pech M, Ricke J. Impact of adjuvant sorafenib treatment after local ablation for HCC in the phase II SORAMIC trial. JHEP Rep 2023; 5:100699. [PMID: 36968218 PMCID: PMC10031000 DOI: 10.1016/j.jhepr.2023.100699] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2022] [Revised: 12/22/2022] [Accepted: 01/17/2023] [Indexed: 03/29/2023] Open
Abstract
Background & Aims The aim of the study was to evaluate the efficacy and safety of adjuvant sorafenib treatment compared with placebo in patients with hepatocellular carcinoma who underwent local ablation. Methods The SORAMIC trial is a randomised controlled trial with diagnostic, local ablation, and palliative sub-study arms. After initial imaging within the diagnostic study, patients were assigned to local ablation or palliative arms. In the local ablation cohort, patients were randomised 1:1 to local ablation + sorafenib vs. local ablation + placebo. The primary endpoint was time-to-recurrence (TTR). Secondary endpoints were local control rate and safety in terms of adverse events and quality-of-life. Results The recruitment was terminated prematurely after 104 patients owing to slow recruitment. One patient was excluded because of a technical failure. Fifty-four patients were randomised to local ablation + sorafenib and 49 to local ablation + placebo. Eighty-eight patients who underwent standardised follow-up imaging comprised the per-protocol population. The median TTR was 15.2 months in the sorafenib arm and 16.4 months in the placebo arm (hazard ratio 1.1; 95% CI 0.53-2.2; p = 0.82). Out of 136 lesions ablated within the trial, there was no difference in local recurrence rate between sorafenib (6/69, 8.6%) and placebo groups (5/67, 5.9%; p = 0.792).Overall (92.5% vs. 71.4%, p = 0.008) and drug-related (81.4% vs. 55.1%, p = 0.003) adverse events were more common in the sorafenib arm compared with the placebo arm. Dose reduction because of adverse events were common in the sorafenib arm (79.6% vs. 30.6%, p <0.001). Conclusions Adjuvant sorafenib did not improve in TTR or local control rate after local ablation in patients with hepatocellular carcinoma within the limitations of an early terminated trial. Impact and implications Local ablation is the standard of care treatment in patients with early stages of hepatocellular carcinoma, along with surgical therapies. However, there is a risk of disease recurrence during follow-up. Sorafenib, an oral medication, is a routinely used treatment for patients with advanced hepatocellular carcinoma. This study found that sorafenib treatment after local ablation in people with early hepatocellular carcinoma did not significantly improve the disease-free period compared with placebo. Clinical trial number EudraCT 2009-012576-27, NCT01126645.
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Key Words
- Adjuvant
- BCLC, Barcelona Clinic Liver Cancer
- CONSORT, Consolidated Standards of Reporting Trials
- CT, computed tomography
- ECOG PS, Eastern Cooperative Oncology Group Performance Status
- HCC, hepatocellular carcinoma
- HR, hazard ratio
- Hepatocellular carcinoma
- ITT, intention-to-treat
- Local ablation
- MRI, magnetic resonance imaging
- MWA, microwave ablation
- PP, per protocol
- RFA, radiofrequency ablation
- RFS, relapse-free survival
- SIRT, selective internal radiation therapy
- SORAMIC, SORAfenib in combination with local MICro-therapy guided by gadolinium-EOB-DTPA-enhanced MRI
- Sorafenib
- TTR, time-to-recurrence
- Time-to-recurrence
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Affiliation(s)
- Max Seidensticker
- Department of Radiology, University Hospital, LMU Munich, Munich, Germany
| | - Osman Öcal
- Department of Radiology, University Hospital, LMU Munich, Munich, Germany
| | - Kerstin Schütte
- Department of Internal Medicine and Gastroenterology, Niels-Stensen-Kliniken Marienhospital, Osnabrück, Germany
| | | | - Thomas Berg
- Klinik und Poliklinik für Gastroenterologie, Sektion Hepatologie, Universitätsklinikum Leipzig, Germany
| | - Christian Loewe
- Section of Cardiovascular and Interventional Radiology, Department of Bioimaging and Image-Guided Therapy, Medical University of Vienna, Vienna, Austria
| | - Heinz Josef Klümpen
- Department of Medical Oncology, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, the Netherlands
| | - Otto van Delden
- Department of Radiology and Nuclear Medicine, Academic University Medical Centers, University of Amsterdam, Amsterdam, the Netherlands
| | | | - Najib Ben Khaled
- Department of Medicine II, University Hospital, LMU Munich, Munich, Germany
| | | | | | - Ali Aghdassi
- Department of Medicine A, University Medicine Greifswald, 17489 Greifswald, Germany
| | - Albert Tran
- Pôle Appareil Digestif, Hôpital l'Archet 2, CHU Nice, Route Saint-Antoine de Ginestière - BP 3079, Nice, France
| | - Jean-Pierre Bronowicki
- Department of Hepatology, INSERM U1254, Hôpital de Brabois, CHU de Nancy, University of Lorraine, Nancy, France
| | - Bora Peynircioglu
- Department of Radiology, Hacettepe University Hospital, Ankara, Turkey
| | - Bruno Sangro
- Liver Unit, Clínica Universidad de Navarra and CIBEREHD, Pamplona, Spain
| | - Maciej Pech
- Department of Radiology and Nuclear Medicine, University of Magdeburg, Magdeburg, Germany
| | - Jens Ricke
- Department of Radiology, University Hospital, LMU Munich, Munich, Germany
- Corresponding author. Address: Department of Radiology, University Hospital, Ludwig Maximilian University of Munich, Marchioninistrasse 15, 81377 Munich, Germany. Tel: +49-4400-72750..
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Féray C, Campion L, Mathurin P, Archambreaud I, Mirabel X, Bronowicki JP, Rio E, Perret C, Mineur L, Oberti F, Touchefeu Y, Gournay J, Regnault H, Edeline J, Rode A, Hillion P, Blanc JF, Khac EN, Azoulay D, Luciani A, Preglisasco AG, Faurel-Paul E, Auble H, Mornex F, Merle P. TACE and conformal radiotherapy vs. TACE alone for hepatocellular carcinoma: A randomised controlled trial. JHEP Rep 2023; 5:100689. [PMID: 36937990 PMCID: PMC10017427 DOI: 10.1016/j.jhepr.2023.100689] [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] [Received: 10/14/2022] [Revised: 12/22/2022] [Accepted: 01/16/2023] [Indexed: 01/30/2023] Open
Abstract
Background & Aims Transcatheter arterial chemoembolisation (TACE) is recommended for patients with hepatocellular carcinoma devoid of macrovascular invasion or extrahepatic spread but not eligible for curative therapies. We compared the efficacy and safety of the combination of a single TACE and external conformal radiotherapy (CRT) vs. classical TACE. Methods TACERTE was an open-labelled, randomised controlled trial with a 1:1 allocation rate to two or three TACE (arm A) or one TACE + CRT (arm B). Participants had a mean age of 70 years, and 86% were male. The aetiology was alcohol in 85%. The primary endpoint was liver progression-free survival (PFS) in the intention-to-treat population. The typical CRT schedule was 54 Gy in 18 sessions of 3 Gy. Results Of the 120 participants randomised, 64 were in arm A and 56 in arm B; 100 participants underwent the planned schedule and defined the 'per-protocol' group. In intention-to-treat participants, the liver PFS at 12 and 18 months were 59% and 19% in arm A and 61% and 36% in arm B (hazard ratio [HR] 0.69; 95% CI 0.40-1.18; p = 0.17), respectively. In the per-protocol population, treated liver PFS tended to be better in arm B (HR 0.61; 95% CI 0.34-1.06; p = 0.081) than in arm A. Liver-related grade III-IV adverse events were more frequent in arm B than in arm A. Median overall survival reached 30 months (95% CI 23-35) in arm A and 22 months (95% CI 15.7-26.2) in arm B. Conclusions Although TACE + CRT tended to improve local control, this first Western randomised controlled trial showed that the combined strategy failed to increase PFS or overall survival and led more frequently to liver-related adverse effects. Impact and implications Hepatocellular carcinoma is frequently treated by arterial embolisation of the tumour and more recently by external radiotherapy. We tried to determine whether combination of the two treatments (irradiation after embolisation) might produce interesting results. Our results in this prospective randomised study were not able to demonstrate a beneficial effect of combining embolisation and irradiation in these patients. On the contrary, we observed more adverse effects with the combined treatment. Clinical Trials Registration NCT01300143.
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Key Words
- 3-DCRT, three-dimensional conformal radiotherapy
- AE, adverse event
- ALBI, albumin–bilirubin
- BCLC, Barcelona Clinic Liver Cancer
- CRT, conformal radiotherapy
- CT, computed tomography
- CTV, clinical tumour volume
- Conformal external radiotherapy
- ECOG, Eastern Cooperative Oncology Group
- HCC, hepatocellular carcinoma
- HR, hazard ratio
- Hepatocellular carcinoma
- ITT, intention-to-treat
- OS, overall survival
- PFS, progression-free survival
- PS, propensity score
- RILD, radio-induced liver disease
- SBRT, stereotaxic body radiation therapy
- TACE, transcatheter arterial chemoembolisation
- TTP, time to tumour progression
- mRECIST, modified Response Evaluation Criteria in Solid Tumour
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Affiliation(s)
- Cyrille Féray
- Centre Hepato-Biliaire, Hôpital Paul Brousse, APHP, Université Paris-Saclay, INSERM 1193, Villejuif, France
- Corresponding author. Address: Centre Hépato Biliaire, Hôpital Paul Brousse. Villejuif, 94800. France. Tel.: +33 1 45596780.
| | - Loic Campion
- Department of Biostatistics, Institut de Cancérologie de l'Ouest, Université Nantes, INSERM U307, Nantes, France
| | - Philippe Mathurin
- Service des Maladies de l'Appareil Digestif, Hôpital Huriez, Université Lille, INSERM 1286, Lille, France
| | | | - Xavier Mirabel
- Department of Radiation Oncology, Centre Oscar Lambret, Lille, France
| | | | - Emmanuel Rio
- Department of Radiation Oncology, Institut de Cancérologie de l'Ouest, Saint Herblain, France
| | | | - Laurent Mineur
- Digestive Oncology, Institut Sainte Catherine, Avignon, France
| | - Frédéric Oberti
- Department of Gastroenterology and Hepatology, Centre Hospitalo-universitaire, Angers, France
| | - Yann Touchefeu
- Institut des Maladies de l'Appareil Digestif, Hôtel-Dieu, Nantes, France
| | - Jérôme Gournay
- Institut des Maladies de l'Appareil Digestif, Hôtel-Dieu, Nantes, France
| | - Hélène Regnault
- Department of Gastroenterology and Hepatology, Hôpital Henri Mondor, APHP, Université Paris Est, Creteil, France
| | - Julien Edeline
- Department of Medical Oncology, Centre Eugène Marquis, Rennes, France
| | - Agnès Rode
- Radiology Department, Hôpital de la Croix-Rousse, Hospice Civil de Lyon; Lyon, France
| | - Patrick Hillion
- Department of Gastroenterology and Hepatology, Centre Hospitalo-universitaire, Dijon, France
| | - Jean Frédéric Blanc
- Department of Gastroenterology and Hepatology, Hôpital Sud Haut-Lévêque, Bordeaux, France
| | - Eric Nguyen Khac
- Department of Gastroenterology and Hepatology, Centre Hospitalo-universitaire, Université Amiens, Amiens, France
| | - Daniel Azoulay
- Centre Hepato-Biliaire, Hôpital Paul Brousse, APHP, Université Paris-Saclay, INSERM 1193, Villejuif, France
| | - Alain Luciani
- Radiology Department, Hôpital Henri Mondor, APHP, Créteil, France
| | | | | | - Hélène Auble
- Direction de la Recherche Medicale, Hôtel-Dieu, Nantes, France
| | - Françoise Mornex
- Department of Radiation Oncology, Centre Hospitalier Lyon Sud, Hospices Civils de Lyon, Université Claude Bernard Lyon, EMR 3738, Lyon, France
| | - Philippe Merle
- Hepatology and Gastroenterology Unit, Hôpital de la Croix-Rousse, Hospices Civils de Lyon, Université Claude Bernard, INSERM U1052, Lyon, France
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Shah SZ, Alvarez FG, Sanghavi DK, Moreno Franco P, Isha S, Marquez CP, Libertin C, Guru PK, Sareyyupoglu B, Pham SM. Coronavirus Disease 2019 Causing Infection of Transplanted Lung Allograft: A Pitfall of Prolonged Shedding of Severe Acute Respiratory Syndrome Coronavirus-2 Pretransplant. Mayo Clin Proc Innov Qual Outcomes 2023; 7:93-98. [PMID: 36644594 PMCID: PMC9829600 DOI: 10.1016/j.mayocpiqo.2023.01.001] [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: 10/20/2022] [Revised: 12/25/2022] [Accepted: 01/03/2023] [Indexed: 01/11/2023] Open
Abstract
Coronavirus disease 2019 (COVID-19) pandemic has led to considerable morbidity and mortality across the world. Lung transplant is a viable option for a few with COVID-19-related lung disease. Whom and when to transplant has been the major question impacting the transplant community given the novelty of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). We describe a pitfall of presumed prolonged shedding of SARS-CoV-2 in a patient with COVID-19 associated acute respiratory distress syndrome leading to COVID-19 pneumonia after lung transplant. This raises concerns that replication-competent SARS-CoV-2 virus can persist for months post-infection and can lead to re-infection of grafts in the future.
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Key Words
- BAL, bronchoalveolar lavage
- BSL-3, Biosafety level-3
- COVID-19, coronavirus disease 2019
- CP, convalescent plasma
- CT, computed tomography
- LT, lung transplant
- NPS, nasopharyngeal swab
- RT-PCR, reverse transcriptase–polymerase chain reaction
- SARS-CoV-2, severe acute respiratory syndrome coronavirus 2
- VV-ECMO, veno-venous extracorporeal membrane oxygenation
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Affiliation(s)
- Sadia Z. Shah
- Department of Transplantation, Mayo Clinic, Jacksonville, FL,Correspondence: Address to Sadia Z. Shah, Department of Transplantation, Mayo Clinic, 4500 San Pablo Rd S, Jacksonville, FL 32224
| | | | | | | | - Shahin Isha
- Department of Critical Care, Mayo Clinic, Jacksonville, FL
| | | | - Claudia Libertin
- Division of Infectious Disease, Department of Medicine, and Mayo Clinic, Jacksonville, FL
| | - Pramod K. Guru
- Department of Critical Care, Mayo Clinic, Jacksonville, FL
| | | | - Si M. Pham
- Department of Cardiothoracic Surgery, Mayo Clinic, Jacksonville, FL
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Bang C, Bernard G, Le WT, Lalonde A, Kadoury S, Bahig H. Artificial intelligence to predict outcomes of head and neck radiotherapy. Clin Transl Radiat Oncol 2023; 39:100590. [PMID: 36935854 PMCID: PMC10014342 DOI: 10.1016/j.ctro.2023.100590] [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: 01/13/2023] [Revised: 01/28/2023] [Accepted: 01/28/2023] [Indexed: 02/01/2023] Open
Abstract
Head and neck radiotherapy induces important toxicity, and its efficacy and tolerance vary widely across patients. Advancements in radiotherapy delivery techniques, along with the increased quality and frequency of image guidance, offer a unique opportunity to individualize radiotherapy based on imaging biomarkers, with the aim of improving radiation efficacy while reducing its toxicity. Various artificial intelligence models integrating clinical data and radiomics have shown encouraging results for toxicity and cancer control outcomes prediction in head and neck cancer radiotherapy. Clinical implementation of these models could lead to individualized risk-based therapeutic decision making, but the reliability of the current studies is limited. Understanding, validating and expanding these models to larger multi-institutional data sets and testing them in the context of clinical trials is needed to ensure safe clinical implementation. This review summarizes the current state of the art of machine learning models for prediction of head and neck cancer radiotherapy outcomes.
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Key Words
- ADASYN, adaptive synthetic sampling
- AI, artificial intelligence
- ANN, artificial neural network
- AUC, Area Under the ROC Curve
- Artificial intelligence
- BMI, body mass index
- C-Index, concordance index
- CART, Classification and Regression Tree
- CBCT, cone-beam computed tomography
- CIFE, conditional informax feature extraction
- CNN, convolutional neural network
- CRT, chemoradiation
- CT, computed tomography
- Cancer outcomes
- DL, deep learning
- DM, distant metastasis
- DSC, Dice Similarity Coefficient
- DSS, clinical decision support systems
- DT, Decision Tree
- DVH, Dose-volume histogram
- GANs, Generative Adversarial Networks
- GB, Gradient boosting
- GPU, graphical process units
- HNC, head and neck cancer
- HPV, human papillomavirus
- HR, hazard ratio
- Head and neck cancer
- IAMB, incremental association Markov blanket
- IBDM, image based data mining
- IBMs, image biomarkers
- IMRT, intensity-modulated RT
- KNN, k nearest neighbor
- LLR, Local linear forest
- LR, logistic regression
- LRR, loco-regional recurrence
- MIFS, mutual information based feature selection
- ML, machine learning
- MRI, Magnetic resonance imaging
- MRMR, Minimum redundancy feature selection
- Machine learning
- N-MLTR, Neural Multi-Task Logistic Regression
- NPC, nasopharynx
- NTCP, Normal Tissue Complication Probability
- OPC, oropharyngeal cancer
- ORN, osteoradionecrosis
- OS, overall survival
- PCA, Principal component analysis
- PET, Positron emission tomography
- PG, parotid glands
- PLR, Positive likelihood ratio
- PM, pharyngeal mucosa
- PTV, Planning target volumes
- PreSANet, deep preprocessor module and self-attention
- Predictive modeling
- QUANTEC, Quantitative Analyses of Normal Tissue Effects in the Clinic
- RF, random forest
- RFC, random forest classifier
- RFS, recurrence free survival
- RLR, Rigid logistic regression
- RRF, Regularized random forest
- RSF, random survival forest
- RT, radiotherapy
- RTLI, radiation-induced temporal lobe injury
- Radiomic
- SDM, shared decision making
- SMG, submandibular glands
- SMOTE, synthetic minority over-sampling technique
- STIC, sticky saliva
- SVC, support vector classifier
- SVM, support vector machine
- XGBoost, extreme gradient boosting
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Affiliation(s)
- Chulmin Bang
- Centre Hospitalier de l’Université de Montréal, Montreal, QC, Canada
- Corresponding author at: Centre Hospitalier de l'Université de Montréal, 3840 Rue Saint-Urbain, Montréal, QC H2W 1T8, Canada.
| | - Galaad Bernard
- Centre Hospitalier de l’Université de Montréal, Montreal, QC, Canada
| | - William T. Le
- Centre de recherche du Centre Hospitalier de l’Université de Montréal, Montreal, QC, Canada
- Polytechnique Montréal, Montreal, QC, Canada
| | - Arthur Lalonde
- Centre Hospitalier de l’Université de Montréal, Montreal, QC, Canada
- Centre de recherche du Centre Hospitalier de l’Université de Montréal, Montreal, QC, Canada
- Université de Montréal, Montreal, QC, Canada
| | - Samuel Kadoury
- Centre de recherche du Centre Hospitalier de l’Université de Montréal, Montreal, QC, Canada
- Polytechnique Montréal, Montreal, QC, Canada
| | - Houda Bahig
- Centre Hospitalier de l’Université de Montréal, Montreal, QC, Canada
- Centre de recherche du Centre Hospitalier de l’Université de Montréal, Montreal, QC, Canada
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7
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Chen L, Ruan S, Wang P, Cheng Y, Wang Y, Tian W, Zhang H, Zhang X, Liang W. Imaging features of primary hepatic sarcomatoid carcinoma: Differentiation from hepatocellular carcinoma and intrahepatic cholangiocarcinoma on CT: A preliminary study. Heliyon 2023; 9:e14123. [PMID: 36938423 PMCID: PMC10018468 DOI: 10.1016/j.heliyon.2023.e14123] [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: 03/21/2022] [Revised: 02/08/2023] [Accepted: 02/21/2023] [Indexed: 03/06/2023] Open
Abstract
Purpose Primary hepatic sarcomatoid carcinoma (PHSC) is a rare type of malignant tumor in the liver. Nevertheless, few studies have focused on the imaging diagnosis of PHSC. In this study, we collected clinical and computed tomography (CT) imaging data of PHSC from two institutions, aiming to investigate the clinical and radiological characteristics of PHSC. Methods We retrospectively investigated the clinical characteristics and CT features of 22 PHSC patients (19 males and 3 females; mean age, 63.4 years; range, 49 to 76 years), 95 hepatocellular carcinoma (HCC) patients and 50 intrahepatic cholangiocarcinoma (ICC) patients. Two radiologists independently evaluated the CT features of the three groups. Subsequently, we analyzed the differences in the clinical characteristics and CT features between the PHSC and control groups. Results Most PHSCs were larger than 5 cm (72.7%). PHSC mainly showed irregular (81.8%), heterogeneous (100%) masses with ill-defined (72.7%) borders with necrosis (86.4%) on CT, which are more common CT features versus HCC (p < 0.001). In the arterial phase, PHSC always showed noticeable heterogeneous enhancement (100.0%), mainly manifesting as partial arterial phase hyperenhancement (APHE) (86.4%). The enhancement patterns of PHSC mainly included delayed progressive enhancement (72.7%), nonperipheral washout (22.7%), and unclassified enhancement (4.5%), which were significantly different from the HCC enhancement pattern but similar to the enhancement pattern of ICC. In addition, vein tumor thrombus (18.2%), intrahepatic metastasis (27.3%), and lymphadenopathy (27.3%) were relatively common in PHSC. Furthermore, most PHSC tumors classified as LR-M (66.7%) were similar to ICC. Conclusions PHSC generally presents as irregularly large masses with necrosis, intrahepatic metastasis, and lymphadenopathy. The CT enhancement of PHSC is mainly part of APHE and delayed progressive enhancement.
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Key Words
- AFP, alpha-fetoprotein
- APHE, arterial phase hyperenhancement
- CA125, carbohydrate antigen 12-5
- CA199, carbohydrate antigen 19-9
- CEA, carcinoembryonic antigen
- CKpan, pan-cytokeratin
- CT, computed tomography
- Computed tomography
- GPC3, glypican-3
- H&E, hematoxylin-eosin
- HCC, hepatocellular carcinoma
- Hepatic sarcomatoid carcinoma
- Hepatocellular carcinoma
- ICC, intrahepatic cholangiocarcinoma
- Imaging
- Intrahepatic cholangiocarcinoma
- MRI, magnetic resonance imaging
- PHSC, primary hepatic sarcomatoid carcinoma
- TACE, transcatheter arterial chemoembolization
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Affiliation(s)
- Lintao Chen
- Department of Radiology, Yiwu Central Hospital, Yiwu, Zhejiang, China
- Department of Radiology, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, Zhejiang, China
| | - Shijian Ruan
- College of Information Science & Electronic Engineering, Zhejiang University, Hangzhou, Zhejiang, China
| | - Pan Wang
- Department of Radiology, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, Zhejiang, China
| | - Yongna Cheng
- Department of Radiology, Yiwu Central Hospital, Yiwu, Zhejiang, China
| | - Yubizhuo Wang
- Department of Radiology, Yiwu Central Hospital, Yiwu, Zhejiang, China
- Department of Radiology, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, Zhejiang, China
| | - Wuwei Tian
- College of Information Science & Electronic Engineering, Zhejiang University, Hangzhou, Zhejiang, China
| | - Hongbin Zhang
- Department of Radiology, Yiwu Central Hospital, Yiwu, Zhejiang, China
| | - Xiuming Zhang
- Department of Pathology, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
| | - Wenjie Liang
- Department of Radiology, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, Zhejiang, China
- Corresponding author. 79# Qingchun Road, Hangzhou, Zhejiang Province, China.
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8
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Ahmed HS, Gangasani N, Jayanna MB, Long MT, Sanchez A, Murali AR. The NAFLD Decompensation Risk Score: External Validation and Comparison to Existing Models to Predict Hepatic Events in a Retrospective Cohort Study. J Clin Exp Hepatol 2023; 13:233-240. [PMID: 36950488 PMCID: PMC10025751 DOI: 10.1016/j.jceh.2022.11.005] [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] [Received: 01/10/2022] [Revised: 10/12/2022] [Accepted: 11/07/2022] [Indexed: 11/14/2022] Open
Abstract
Background The NAFLD decompensation risk score (the Iowa Model) was recently developed to identify patients with nonalcoholic fatty liver disease (NAFLD) at highest risk of developing hepatic events using three variables-age, platelet count, and diabetes. Aims We performed an external validation of the Iowa Model and compared it to existing non-invasive models. Methods We included 249 patients with NAFLD at Boston Medical Center, Boston, Massachusetts, in the external validation cohort and 949 patients in the combined internal/external validation cohort. The primary outcome was the development of hepatic events (ascites, hepatic encephalopathy, esophageal or gastric varices, or hepatocellular carcinoma). We used Cox proportional hazards to analyze the ability of the Iowa Model to predict hepatic events in the external validation (https://uihc.org/non-alcoholic-fatty-liver-disease-decompensation-risk-score-calculator). We compared the performance of the Iowa Model to the AST-to-platelet ratio index (APRI), NAFLD fibrosis score (NFS), and the FIB-4 index in the combined cohort. Results The Iowa Model significantly predicted the development of hepatic events with hazard ratio of 2.5 [95% confidence interval (CI) 1.7-3.9, P < 0.001] and area under the receiver operating characteristic curve (AUROC) of 0.87 (CI 0.83-0.91). The AUROC of the Iowa Model (0.88, CI: 0.85-0.92) was comparable to the FIB-4 index (0.87, CI: 0.83-0.91) and higher than NFS (0.66, CI: 0.63-0.69) and APRI (0.76, CI: 0.73-0.79). Conclusions In an urban, racially and ethnically diverse population, the Iowa Model performed well to identify NAFLD patients at higher risk for liver-related complications. The model provides the individual probability of developing hepatic events and identifies patients in need of early intervention.
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Key Words
- A1AT, alpha-1-antitrypsin
- AASLD, the American Association for the Study of Liver Disease
- ALD, alcoholic liver disease
- ALT, alanine aminotransferase
- APRI, AST-to-Platelet Ratio Index
- AST, aspartate aminotransferase
- AUROC, area under the receiver operating characteristic curve
- BMI, body mass index
- CT, computed tomography
- HCV, hepatitis C infection
- HE, hepatic encephalopathy
- NAFLD, nonalcoholic fatty liver disease
- NASH, nonalcoholic steatohepatitis
- SAS, Statistical Analysis Software
- VCTE, vibration-controlled transient elastography
- cirrhosis
- fatty liver
- nonalcoholic fatty liver disease
- risk assessment
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Affiliation(s)
- Heidi S. Ahmed
- Boston University School of Medicine, Section of Gastroenterology, Boston, MA, USA
| | - Nikitha Gangasani
- Boston University School of Medicine, Department of Internal Medicine, Boston, MA, USA
| | - Manju B. Jayanna
- Lankenau Medical Center and Lankenau Institute for Medical Research, Wynnewood, PA, USA
| | - Michelle T. Long
- Boston University School of Medicine, Section of Gastroenterology, Boston, MA, USA
| | - Antonio Sanchez
- The University of Iowa Hospitals and Clinics, Department of Internal Medicine, Gastroenterology and Hepatology, Iowa City, IA, USA
| | - Arvind R. Murali
- The University of Iowa Hospitals and Clinics, Department of Internal Medicine, Gastroenterology and Hepatology, Iowa City, IA, USA
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9
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Feng C, Wenlin Y, Qiangyong K, Li L, Jingjing Q. Clinical efficacy of combination therapy of FuXi-Tiandi-Wuxing Decoction and anti-viral drugs in the treatment of novel coronavirus pneumonia: A prospective interventional study. J Herb Med 2023; 38:100627. [PMID: 36644210 PMCID: PMC9831664 DOI: 10.1016/j.hermed.2023.100627] [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: 01/20/2021] [Revised: 08/13/2021] [Accepted: 01/09/2023] [Indexed: 01/12/2023]
Abstract
Introduction The National Administration of Traditional Chinese Medicine of the People's Republic of China (NATCM) and the State Administration of Traditional Chinese medicine (TCM) advocated a combination therapy of TCM and anti-viral drugs for novel coronavirus pneumonia (NCP) to improve the efficacy of clinical treatment. Methods Forty-six patients diagnosed with NCP were sequentially divided into intent-to-treat population: the experimental group (combination of FuXi-Tiandi-Wuxing Decoction and anti-viral drugs; n = 23) and the control group (anti-viral drugs only) (n = 23). The two groups were compared in terms of duration of fever, cough symptom score, fatigue, appetite, dyspnea, out-of-bed activities, chest computer tomography (CT) recovery, virological clearance, average length of hospital stay, and clinical effective rate of drug. After 6 days of observation, patients from the control group were divided into as-treated population: experimental subgroup (n = 14) to obtain clinical benefit and control subgroup (n = 9). Results There was a significant improvement in the duration of fever (1.087 ± 0.288 vs 4.304 ± 2.490), cough (0.437 ± 0.589 vs 2.435 ± 0.662; P < 0.05), chest CT evaluation (82.6% vs 43.4%; P < 0.05), and virological clearance (60.8% vs 8.7%; P < 0.05) in patients of the experimental group compared with patients in the control group. Further observation in as-treated population reported that cough (0.742 ± 0.463 vs 1.862 ± 0.347; P < 0.05) and fatigue (78.5% vs 33.3%; P < 0.05) were significantly relieved after adding FuXi-Tiandi-Wuxing Decoction to the existing treatment. Conclusion An early treatment with combination therapy of FuXi-Tiandi-Wuxing Decoction and anti-viral drugs significantly relieves the clinical symptoms of NCP, shows improvement in chest CT scan, improves virological clearance, shortens average length of hospital stay, and reduces the risk of severe illness. The effect of FuXi-Tiandi-Wuxing Decoction in NCP may be clinically important and require further consideration.
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Key Words
- ARDS, acute respiratory distress syndrome
- Anti-viral drug
- COVID-19
- CRS, cytokine release syndrome
- CT, computed tomography
- ELISA, enzyme-linked immunosorbent assay
- H1N1, Hemagglutinin Type 1 and Neuraminidase Type 1
- ITT, intent-to-treat
- NATCM, National Administration of Traditional Chinese Medicine of the People’s Republic of China
- NCP, novel coronavirus pneumonia
- Novel coronavirus pneumonia
- PG, Platycodon grandiflorum
- Prospective
- RT-PCR, reverse transcriptase polymerase chain reaction
- RdRp, RNA-dependent RNA polymerase
- TCM, traditional Chinese medicine
- TNF, tumor necrosis factor
- Traditional Chinese medicine
- WHO, World Health Organization
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Affiliation(s)
- Chen Feng
- People’s Hospital of Xiang Zhou District, Lanpu Rd, Xiangzhou, ICP No. 09154174, Zhuhai, Guangdong Province, China
| | - Yao Wenlin
- People’s Hospital of Xiang Zhou District, Lanpu Rd, Xiangzhou, ICP No. 09154174, Zhuhai, Guangdong Province, China
| | - Kou Qiangyong
- People’s Hospital of Xiang Zhou District, Lanpu Rd, Xiangzhou, ICP No. 09154174, Zhuhai, Guangdong Province, China
| | - Lanting Li
- Shanghai Palan DataRx Co., Ltd, Room 611, Building A, No. 3501 Hechuan Road, Minhang District, 200110 Shanghai, China
| | - Qi Jingjing
- People’s Hospital of Xiang Zhou District, Lanpu Rd, Xiangzhou, ICP No. 09154174, Zhuhai, Guangdong Province, China,Correspondence to: Department of Pneumonology, People’s Hospital of Xiang Zhou District, Lanpu Rd, Xiangzhou, ICP No. 09154174, Zhuhai, Guangdong Province, China
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10
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Medina de Chazal HA, Zgheib A, Al Isma'ili A, Martucci G, Spaziano M, Piazza N. The Role of CT-Guided Optimal Fluoroscopic Viewing Angle for Coronary Engagement After TAVR. JACC Case Rep 2023; 9:101742. [PMID: 36909270 PMCID: PMC9998712 DOI: 10.1016/j.jaccas.2023.101742] [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: 12/05/2022] [Accepted: 12/12/2022] [Indexed: 01/31/2023]
Abstract
We report the case of an 89-year-old woman with prior transcatheter aortic valve replacement who underwent successful left coronary artery engagement and left circumflex percutaneous coronary intervention using patient-specific computed tomography fluoroscopic projections. (Level of Difficulty: Advanced.).
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Affiliation(s)
- Horacio A Medina de Chazal
- Division of Cardiology, Department of Medicine, McGill University Health Center, Glen Hospital, Montreal, Quebec, Canada
| | - Ali Zgheib
- Division of Cardiology, Department of Medicine, McGill University Health Center, Glen Hospital, Montreal, Quebec, Canada
| | - Abdullah Al Isma'ili
- Division of Cardiology, Department of Medicine, McGill University Health Center, Glen Hospital, Montreal, Quebec, Canada
| | - Giuseppe Martucci
- Division of Cardiology, Department of Medicine, McGill University Health Center, Glen Hospital, Montreal, Quebec, Canada
| | - Marco Spaziano
- Division of Cardiology, Department of Medicine, McGill University Health Center, Glen Hospital, Montreal, Quebec, Canada
| | - Nicolo Piazza
- Division of Cardiology, Department of Medicine, McGill University Health Center, Glen Hospital, Montreal, Quebec, Canada
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11
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Alsaleh M, Sithithaworn P, Khuntikeo N, Loilome W, Yongvanit P, Hughes T, O'Connor T, Andrews RH, Wadsworth CA, Williams R, Koomson L, Cox IJ, Holmes E, Taylor-Robinson SD. Urinary Metabolic Profiling of Liver Fluke-Induced Cholangiocarcinoma-A Follow-Up Study. J Clin Exp Hepatol 2023; 13:203-217. [PMID: 36950498 PMCID: PMC10025591 DOI: 10.1016/j.jceh.2022.11.012] [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] [Received: 07/19/2022] [Accepted: 11/21/2022] [Indexed: 11/28/2022] Open
Abstract
Background/Aims Global liquid chromatography mass spectrometry (LC-MS) profiling in a Thai population has previously identified a urinary metabolic signature in Opisthorchis viverrini-induced cholangiocarcinoma (CCA), primarily characterised by disturbance in acylcarnitine, bile acid, steroid, and purine metabolism. However, the detection of thousands of analytes by LC-MS in a biological sample in a single experiment potentially introduces false discovery errors. To verify these observed metabolic perturbations, a second validation dataset from the same population was profiled in a similar fashion. Methods Reverse-phase ultra-performance liquid-chromatography mass spectrometry was utilised to acquire the global spectral profile of 98 spot urine samples (from 46 healthy volunteers and 52 CCA patients) recruited from Khon Kaen, northeast Thailand (the highest incidence of CCA globally). Results Metabolites were differentially expressed in the urinary profiles from CCA patients. High urinary elimination of bile acids was affected by the presence of obstructive jaundice. The urine metabolome associated with non-jaundiced CCA patients showed a distinctive pattern, similar but not identical to published studies. A panel of 10 metabolites achieved a diagnostic accuracy of 93.4% and area under the curve value of 98.8% (CI = 96.3%-100%) for the presence of CCA. Conclusions Global characterisation of the CCA urinary metabolome identified several metabolites of biological interest in this validation study. Analyses of the diagnostic utility of the discriminant metabolites showed excellent diagnostic potential. Further larger scale studies are required to confirm these findings internationally, particularly in comparison to sporadic CCA, not associated with liver fluke infestation.
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Key Words
- ANOVA, analysis of variance
- BCAA, branched chain amino acids
- CCA, cholangiocarcinoma
- CID, collision-induced dissociation
- CT, computed tomography
- CV-ANOVA, ANOVA of cross-validated residuals
- DDA, data-dependent acquisition
- ESI −, electrospray ionisation negative mode
- ESI, electrospray ionisation
- ESI +, electro spray ionisation positive mode
- LC-MS, liquid chromatography mass spectroscopy
- MRI, magnetic resonance imaging
- NMR, nuclear magnetic resonance
- OPLS-DA, orthogonal projections to latent structures discriminant analysis
- QC, quality control
- ROC, receiver operating characteristic
- RP, reverse phase
- TOF, time of flight
- UPLC, ultra-performance liquid chromatography
- biomarkers
- cholangiocarcinoma
- dCCA, distal cholangiocarcinoma
- iCCA, intrahepatic cholangiocarcinoma
- liver fluke
- mass spectroscopy
- pCCA, perihilar cholangiocarcinoma
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Affiliation(s)
- Munirah Alsaleh
- Department of Metabolism, Digestion and Reproduction, Imperial College London, St Mary's Hospital Campus, London W2 INY, United Kingdom
| | - Paiboon Sithithaworn
- Cholangiocarcinoma Research Institute, Faculty of Medicine, Khon Kaen University, Khon Kaen 40002, Thailand
| | - Narong Khuntikeo
- Cholangiocarcinoma Research Institute, Faculty of Medicine, Khon Kaen University, Khon Kaen 40002, Thailand
| | - Watcharin Loilome
- Cholangiocarcinoma Research Institute, Faculty of Medicine, Khon Kaen University, Khon Kaen 40002, Thailand
| | - Puangrat Yongvanit
- Cholangiocarcinoma Research Institute, Faculty of Medicine, Khon Kaen University, Khon Kaen 40002, Thailand
| | - Thomas Hughes
- Department of Metabolism, Digestion and Reproduction, Imperial College London, St Mary's Hospital Campus, London W2 INY, United Kingdom
| | - Thomas O'Connor
- Department of Metabolism, Digestion and Reproduction, Imperial College London, St Mary's Hospital Campus, London W2 INY, United Kingdom
| | - Ross H. Andrews
- Department of Metabolism, Digestion and Reproduction, Imperial College London, St Mary's Hospital Campus, London W2 INY, United Kingdom
- Cholangiocarcinoma Research Institute, Faculty of Medicine, Khon Kaen University, Khon Kaen 40002, Thailand
| | - Christopher A. Wadsworth
- Department of Metabolism, Digestion and Reproduction, Imperial College London, St Mary's Hospital Campus, London W2 INY, United Kingdom
| | - Roger Williams
- The Roger Williams Institute of Hepatology, Foundation for Liver Research, 111 Coldharbour Lane, London SE5 9NT, United Kingdom
- Faculty of Life Sciences & Medicine, King's College London, United Kingdom
| | - Larry Koomson
- Department of Metabolism, Digestion and Reproduction, Imperial College London, St Mary's Hospital Campus, London W2 INY, United Kingdom
| | - Isobel Jane Cox
- The Roger Williams Institute of Hepatology, Foundation for Liver Research, 111 Coldharbour Lane, London SE5 9NT, United Kingdom
- Faculty of Life Sciences & Medicine, King's College London, United Kingdom
| | - Elaine Holmes
- Department of Metabolism, Digestion and Reproduction, Imperial College London, St Mary's Hospital Campus, London W2 INY, United Kingdom
| | - Simon D. Taylor-Robinson
- Department of Metabolism, Digestion and Reproduction, Imperial College London, St Mary's Hospital Campus, London W2 INY, United Kingdom
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12
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Treichel AM, Boeszoermenyi B, Lee CCR, Moss J, Kwiatkowski DJ, Darling TN. Diagnosis of Mosaic Tuberous Sclerosis Complex Using Next-Generation Sequencing of Subtle or Unusual Cutaneous Findings. JID Innov 2023; 3:100180. [PMID: 36960317 PMCID: PMC10030254 DOI: 10.1016/j.xjidi.2023.100180] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2021] [Revised: 11/08/2021] [Accepted: 11/10/2021] [Indexed: 01/11/2023] Open
Abstract
Skin findings can be critical to determining whether a patient with lymphangioleiomyomatosis (LAM), a progressive pulmonary disease that predominantly affects adult women, has sporadic LAM or LAM in association with tuberous sclerosis complex (TSC). Three individuals with LAM underwent evaluation for TSC-associated mucocutaneous and internal findings. We used our previously published algorithm to confirm the clinical suspicion for mosaicism and guide the selection of tissue specimens and genetic workup. Next-generation sequencing of cutaneous findings was used to confirm clinical suspicion for mosaic TSC in individuals with LAM. Two individuals previously thought to have sporadic LAM were diagnosed with mosaic TSC-associated LAM upon next-generation sequencing of unilateral angiofibromas in one and an unusual cutaneous hamartoma in the other. A third individual, diagnosed with TSC in childhood, was found to have a mosaic pathogenic variant in TSC2 in cutaneous tissue from a digit with macrodactyly. Accurate diagnosis of mosaic TSC-associated LAM may require enhanced genetic testing and is important because of the implications regarding surveillance, prognosis, and risk of transmission to offspring.
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Affiliation(s)
- Alison M. Treichel
- Department of Dermatology, University Hospitals Cleveland Medical Center, Case Western Reserve University, Cleveland, Ohio, USA
| | - Barbara Boeszoermenyi
- Cancer Genetics Laboratory, Division of Pulmonary and Critical Care Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Chyi-Chia Richard Lee
- Laboratory of Pathology, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - Joel Moss
- Pulmonary Branch, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - David J. Kwiatkowski
- Cancer Genetics Laboratory, Division of Pulmonary and Critical Care Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Thomas N. Darling
- Department of Dermatology, F. Edward Hebert School of Medicine, Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA
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13
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Pezzato A, Fabris E, Korcova R, Belgrano M, Sinagra G. Long-Term Follow-Up of a Nonprogressive Left Main Coronary Artery Fistula to Right Atrium. JACC Case Rep 2023; 9:101735. [PMID: 36909265 PMCID: PMC9998730 DOI: 10.1016/j.jaccas.2023.101735] [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: 10/19/2022] [Revised: 12/15/2022] [Accepted: 12/27/2022] [Indexed: 01/28/2023]
Abstract
Coronary artery fistula is a rare cardiac abnormality, occurring more frequently in young patients and treated with cardiac surgery or percutaneous interventions in most cases. We present the case of a 63-year-old man with an incidental diagnosis of coronary artery fistula, treated with conservative strategy. (Level of Difficulty: Intermediate.).
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Affiliation(s)
- Andrea Pezzato
- Cardiothoracic Department, Azienda Sanitaria Universitaria Integrata di Trieste, University of Trieste, Trieste, Italy
| | - Enrico Fabris
- Cardiothoracic Department, Azienda Sanitaria Universitaria Integrata di Trieste, University of Trieste, Trieste, Italy
| | - Renata Korcova
- Cardiothoracic Department, Azienda Sanitaria Universitaria Integrata di Trieste, University of Trieste, Trieste, Italy
| | - Manuel Belgrano
- Department of Radiology, Azienda Sanitaria Universitaria Integrata of Trieste, University of Trieste, Trieste, Italy
| | - Gianfranco Sinagra
- Cardiothoracic Department, Azienda Sanitaria Universitaria Integrata di Trieste, University of Trieste, Trieste, Italy
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14
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Yanagida K, Watanabe D, Yoshida T, Kawae N, Mizushima A, Nakagawa T. Obstructive urosepsis caused by ureterosciatic hernia: A case report. Urol Case Rep 2023; 47:102372. [PMID: 36915703 PMCID: PMC10006703 DOI: 10.1016/j.eucr.2023.102372] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Accepted: 03/01/2023] [Indexed: 03/05/2023] Open
Abstract
Ureterosciatic hernia (USH) is a relatively rare cause of ureteral obstruction. We report a case of a patient with obstructive urosepsis caused by USH and treated by ureteral stenting. An 83-year-old woman came to our hospital with symptoms of left lumbar back pain and fever. Enhanced computed tomography showed left hydronephrosis and ureteral protrusion through the greater foramen sciaticum. The patient was diagnosed with USH and underwent transurethral ureteral stenting. Eight months later, the ureteral stent was removed. There has been no recurrence of USH 6 months after removal of the ureteral stent.
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Affiliation(s)
- Kazuki Yanagida
- Department of Urology, Koto Hospital, Koto-ku, Tokyo, Japan
- Department of Urology, Teikyo University School of Medicine, Itabashi-ku, Tokyo, Japan
| | - Daisuke Watanabe
- Department of Urology, Koto Hospital, Koto-ku, Tokyo, Japan
- Department of Palliative Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan
- Corresponding author. Department of Palliative Medicine, Juntendo University Graduate School of Medicine, 2-1-1 Hongo, Bunkyo-ku, Tokyo, 113-8421, Japan.
| | - Takahiro Yoshida
- Department of Urology, Koto Hospital, Koto-ku, Tokyo, Japan
- Department of Urology, Teikyo University School of Medicine, Itabashi-ku, Tokyo, Japan
| | - Norikazu Kawae
- Department of Palliative Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan
- Department of Radiology, Koto Hospital, Koto-ku, Tokyo, Japan
| | - Akio Mizushima
- Department of Palliative Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Tohru Nakagawa
- Department of Urology, Teikyo University School of Medicine, Itabashi-ku, Tokyo, Japan
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15
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Su BY, Wang YC, Weng MJ, Chen MC. Trans-arterial embolization of a Yakes type IIb inferior mesenteric arteriovenous malformation: A case report and literature review for angio-architecture analysis. Radiol Case Rep 2023; 18:1620-7. [PMID: 36865618 DOI: 10.1016/j.radcr.2023.01.069] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2023] [Revised: 01/16/2023] [Accepted: 01/17/2023] [Indexed: 02/18/2023] Open
Abstract
We herein report a case of acute, massive lower gastrointestinal bleeding caused by Yakes type IIb inferior mesenteric arteriovenous malformation, which was successfully treated with endovascular embolization. The Yakes arteriovenous malformation classification provides curative treatment strategies based on specific angioarchitecture, thus serving as a valuable guide during treatment planning. We reviewed reported cases from 1988 to 2022 and conducted an angioarchitecture analysis based on the Yakes classification. We analyzed these reported cases to estimate the treatment success rates of surgery and embolization.
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16
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Kai K, Fujiwara T, Nagao Y, Oki E, Yoshizumi T, Eto M, Nakashima Y. Evaluation of bone density and skeletal muscle mass after sleeve gastrectomy using computed tomography method. Bone Rep 2023; 18:101661. [PMID: 36846622 DOI: 10.1016/j.bonr.2023.101661] [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] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2022] [Revised: 01/20/2023] [Accepted: 02/09/2023] [Indexed: 02/13/2023] Open
Abstract
Introduction Sleeve gastrectomy is the most common surgical procedure to reduce weight and treat metabolic complications in patients with moderate-to-severe obesity; however, it affects the musculoskeletal system. Dual-energy X-ray absorptiometry (DXA), which is commonly used to measure bone mineral density (BMD), may be affected by excess fat tissue around the bones, interrupting BMD measurement. Due to the strong correlation between DXA and the Hounsfield units (HU) obtained from computed tomography (CT) scans, BMD assessment using clinical abdominal CT scans has been useful. To date, there has been no report of detailed CT evaluation in patients with severe obesity after sleeve gastrectomy. Objective This study investigated the effect of sleeve gastrectomy in severely obese patients on bone and psoas muscle density, and cross-sectional area using retrospective clinical CT scans. Methods This was a retrospective observational study that included 86 patients (35 males and 51 females) who underwent sleeve gastrectomy between March 2012 and May 2019. Patients' clinical data (age at the time of surgery, sex, body weight, body mass index (BMI), comorbidities, and preoperative and postoperative blood test results, HU of the lumbar spine and psoas muscle and psoas muscle mass index (PMI)) were evaluated. Results The mean age at the time of surgery was 43 years, and the body weight and BMI significantly reduced (p < 0.01) after surgery. The mean hemoglobin A1c level showed significant improvement in males and females. Serum calcium and phosphorus levels remained unchanged before and after surgery. In CT analysis, HU of the lumbar spine and psoas muscle showed no significant decrease, but PMI showed a significant decrease (p < 0.01). Conclusions Sleeve gastrectomy could dramatically improve anthropometric measures without causing changes in serum calcium and phosphorus levels. Preoperative and postoperative abdominal CT revealed no significant difference in the bone and psoas muscle density, and the psoas muscle mass was significantly decreased after sleeve gastrectomy.
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Iizuka Y, Hiraoka M, Kokubo M, Sakamoto T, Karasawa K, Murofushi K, Nakamura M, Matsuo Y, Morita S, Inokuchi H, Mizowaki T. Dynamic tumor-tracking stereotactic body radiotherapy with real-time monitoring of liver tumors using a gimbal-mounted linac: A multi-institutional phase II study. Clin Transl Radiat Oncol 2023; 39:100591. [PMID: 36852258 PMCID: PMC9958254 DOI: 10.1016/j.ctro.2023.100591] [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: 01/25/2023] [Accepted: 02/05/2023] [Indexed: 02/12/2023] Open
Abstract
Background and purpose This prospective multicenter phase II study aimed to evaluate the safety and efficacy of dynamic tumor tracking (DTT) stereotactic body radiotherapy (SBRT) with real-time monitoring of liver tumors using a gimbal-mounted system. Materials and methods Patients with < 4 primary or metastatic liver tumors with diameters ≤ 50 mm and expected to have a respiratory motion of ≥ 10 mm were eligible. The prescribed dose was 40 Gy in five fractions. The primary endpoint was local control (LC) at 2 years. The secondary endpoints were overall survival (OS), progression-free survival (PFS), treatment-related toxicity, and tracking accuracy. Results Between September 2015 and March 2019, 48 patients (48 lesions) with a median age of 74 years were enrolled from four institutions. Of these, 39 were diagnosed with hepatocellular carcinoma and nine with metastatic liver cancer. The median tumor diameter was 17.5 mm. DTT-SBRT was successfully performed in all patients; the median treatment time was 28 min/fraction. The median follow-up period was 36.5 months. The 2-year LC, OS, and PFS rates were 98.0 %, 88.8 %, and 55.1 %, respectively. Disease progression was observed in 33 (68.8 %) patients. One patient (0.2 %) had local recurrence, 31 (64.6 %) developed new hepatic lesions outside the irradiation field, and nine (18.8 %) had distant metastases (including overlap). Grade 3 late adverse events were observed in seven patients (14.5 %). No grade 4 or 5 treatment-related toxicity was observed. The median tracking accuracy was 2.9 mm. Conclusion Employing DTT-SBRT to treat liver tumors results in excellent LC with acceptable adverse-event incidence.
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Key Words
- 4D, four-dimensional
- CT, computed tomography
- CTV, clinical target volume
- DTT, dynamic tumor tracking
- Dynamic tumor tracking
- GTV, gross tumor volume
- HCC, hepatocellular carcinoma
- IR, infrared
- LC, local control
- Liver
- Malignant neoplasms
- Metastasis
- OAR, organs at risk
- OS, overall survival
- PFS, progression-free survival
- PTV, planning target volume
- RFA, radiofrequency ablation
- SBRT, stereotactic body radiotherapy
- Stereotactic body radiotherapy
- TV, target volume
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Affiliation(s)
- Yusuke Iizuka
- Department of Radiation Oncology and Image-Applied Therapy, Kyoto University Graduate School of Medicine, Japan
- Corresponding author at: 54 Shogoin-Kawaharacho, Sakyo, Kyoto 6068507, Japan.
| | - Masahiro Hiraoka
- Department of Radiation Oncology, Japanese Red Cross Society Wakayama Medical Center, Japan
| | - Masaki Kokubo
- Department of Radiation Oncology, Kobe City Medical Center General Hospital, Japan
| | | | - Katsuyuki Karasawa
- Division of Radiation Oncology, Department of Radiology, Tokyo Metropolitan Cancer and Infectious Diseases Center Komagome Hospital, Japan
| | - Keiko Murofushi
- Division of Radiation Oncology, Department of Radiology, Tokyo Metropolitan Cancer and Infectious Diseases Center Komagome Hospital, Japan
| | - Mitsuhiro Nakamura
- Division of Medical Physics, Department of Information Technology and Medical Engineering, Human Health Sciences, Kyoto University, Japan
| | - Yukinori Matsuo
- Department of Radiation Oncology and Image-Applied Therapy, Kyoto University Graduate School of Medicine, Japan
| | - Satoshi Morita
- Department of Biomedical Statistics and Bioinformatics, Kyoto University Graduate School of Medicine, Japan
| | - Haruo Inokuchi
- Department of Radiation Oncology, Japanese Red Cross Society Wakayama Medical Center, Japan
| | - Takashi Mizowaki
- Department of Radiation Oncology and Image-Applied Therapy, Kyoto University Graduate School of Medicine, Japan
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18
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Farkas Á, Tomisa G, Kugler S, Nagy A, Vaskó A, Kis E, Szénási G, Gálffy G, Horváth A. The effect of exhalation before the inhalation of dry powder aerosol drugs on the breathing parameters, emitted doses and aerosol size distributions. Int J Pharm X 2023; 5:100167. [PMID: 36824288 PMCID: PMC9941374 DOI: 10.1016/j.ijpx.2023.100167] [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: 12/15/2022] [Revised: 02/01/2023] [Accepted: 02/02/2023] [Indexed: 02/06/2023] Open
Abstract
Airway deposition of aerosol drugs is highly dependent on the breathing manoeuvre of the patients. Though incorrect exhalation before the inhalation of the drug is one of the most common mistakes, its effect on the rest of the manoeuvre and on the airway deposition distribution of aerosol drugs is not explored in the open literature. The aim of the present work was to conduct inhalation experiments using six dry powder inhalers in order to quantify the effect of the degree of lung emptying on the inhalation time, inhaled volume and peak inhalation flow. Another goal of the research was to determine the effect of the exhalation on the aerodynamic properties of the drugs emitted by the same inhalers. According to the measurements, deep exhalation before drug inhalation increased the volume of the inhaled air and the average and maximum values of the inhalation flow rate, but the extent of the increase was patient and inhaler specific. For different inhalers, the mean value of the relative increase in peak inhalation flow due to forceful exhalation was between 15.3 and 38.4% (min: Easyhaler®, max: Breezhaler®), compared to the case of normal (tidal) exhalation before the drug inhalation. The relative increase in the inhaled volume was between 36.4 and 57.1% (min: NEXThaler®, max: Turbuhaler®). By the same token, forceful exhalation resulted in higher emitted doses and smaller emitted particles, depending on the individual breathing ability of the patient, the inhalation device and the drug metered in it. The relative increase in the emitted dose varied between 0.2 and 8.0% (min: Foster® NEXThaler®, max: Bufomix® Easyhaler®), while the relative enhancement of fine particle dose ranged between 1.9 and 30.8% (min: Foster® NEXThaler®, max: Symbicort® Turbuhaler®), depending on the inhaler. All these effects and parameter values point toward higher airway doses due to forceful exhalation before the inhalation of the drug. At the same time, the present findings highlight the necessity of proper patient education on the importance of lung emptying, but also the importance of patient-specific inhaler-drug pair choice in the future.
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Key Words
- AF, aerosolized fraction
- Aerosol drug delivery
- BMI, body mass index
- Breathing parameters
- CAD, computer aided design
- COPD, chronic obstructive pulmonary disease
- CT, computed tomography
- DPI, dry powder inhaler
- Dry powder inhalers
- ED, emitted dose
- FEV1, expiratory volume at the end of the first second of forced exhalation
- FPF, fine particle fraction
- FVC, forced vital capacity
- GSD, geometric standard deviation
- ICS, inhalation cortico-steroid
- IV, inhaled volume
- IVC, inspiratory vital capacity
- IVdev, inhaled volume through an inhalation device
- Inhalation therapy
- LABA, long-acting beta-agonist
- Lung emptying
- MMAD, mass median aerodynamic diameter
- PEF, peak expiratory flow
- PIF, peak inhalation flow
- PIFdev, peak inhalation flow through an inhalation device
- PIL, patient information leaflet
- Q, mean inhalation flow rate
- Qdev, mean inhalation flow rate through an inhalation device
- SPC, summary of product characteristics
- tin, inhalation time
- tin-dev, inhalation time through an inhalation device
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Affiliation(s)
- Árpád Farkas
- Centre for Energy Research, Konkoly Thege M. út 29-33, 1121 Budapest, Hungary,Corresponding author at: Centre for Energy Research, Konkoly-Thege Miklós út 29-33, 1121 Budapest, Hungary.
| | - Gábor Tomisa
- Chiesi Hungary Kft., Dunavirág utca 2, 1138 Budapest, Hungary
| | - Szilvia Kugler
- Centre for Energy Research, Konkoly Thege M. út 29-33, 1121 Budapest, Hungary
| | - Attila Nagy
- Wigner Research Centre for Physics, Konkoly Thege M. út 29-33, 1121 Budapest, Hungary
| | - Attila Vaskó
- Pulmonology Clinic, University of Debrecen, Nagyerdei krt. 98, 4032 Debrecen, Hungary
| | - Erika Kis
- Babes-Bolyai University, Hungarian Department of Biology and Ecology, Cluj-Napoca, Romania
| | | | - Gabriella Gálffy
- County Institute of Pulmonology, Department of Pulmonology, Munkácsy M. u. 70, 2045 Törökbálint, Hungary
| | - Alpár Horváth
- Chiesi Hungary Kft., Dunavirág utca 2, 1138 Budapest, Hungary
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Shirzadi R, Roshanzamir Z, Pak N, Rajabi R, Mohammadi F. An unusual site of a pericardial cyst in a child: A case report. Radiol Case Rep 2023; 18:1498-1501. [PMID: 36816338 PMCID: PMC9932291 DOI: 10.1016/j.radcr.2023.01.010] [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: 12/14/2022] [Revised: 01/03/2023] [Accepted: 01/04/2023] [Indexed: 02/05/2023] Open
Abstract
Pericardial cysts are rare congenital anomalies, often clinically silent and incidentally found on imaging. However, patients with pericardial cysts may present with chest pain, tachypnea, and, rarely, symptoms secondary to cardiac tamponade. Echocardiography (transthoracic or transesophageal) and chest computed tomography (CT) scan with contrast are diagnostic modalities of choice in patients with pericardial cysts. Conservative management is justified in asymptomatic patients, while a surgical approach is recommended in symptomatic patients. Here, we describe the case of a 12-year-old boy who underwent imaging during the coronavirus disease 2019 (COVID-19) pandemic and was incidentally found to have a pericardial cyst.
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Affiliation(s)
- Rohola Shirzadi
- Pediatric Respiratory and Sleep Medicine Research Center, Children's Medical Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Zahra Roshanzamir
- Pediatric Respiratory and Sleep Medicine Research Center, Children's Medical Center, Tehran University of Medical Sciences, Tehran, Iran,Pediatric Respiratory Center, Namazi Hospital, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Neda Pak
- Department of Radiology, Children's Medical Center, Tehran University of Medical Sciences, Tehran, Iran
| | | | - Fatemeh Mohammadi
- Tehran University of Medical Sciences, Tehran, Iran,Children's Medical Center, No 63, Gharib Ave, Keshavarz Blvd., Tehran, 14194, Iran,Corresponding author.
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20
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Mellander H, Fransson V, Ydström K, Lätt J, Ullberg T, Wassélius J, Ramgren B. Metal artifact reduction by virtual monoenergetic reconstructions from spectral brain CT. Eur J Radiol Open 2023; 10:100479. [PMID: 36819113 DOI: 10.1016/j.ejro.2023.100479] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2023] [Accepted: 01/29/2023] [Indexed: 02/05/2023] Open
Abstract
Purpose Conventional computed tomography (CT) images are severely affected by metal artifacts in patients with intracranial coils. Monoenergetic images have been suggested to reduce metal artifacts.The aim of this study was to assess metal artifacts in virtual monoenergetic images (VMIs) reconstructed from spectral brain CT. Methods Thirty-two consecutive patients with intracranial coils examined by spectral non contrast brain CT (NCCT) at our center between November 2017 and April 2019 were included. Attenuation and standard deviations were measured in regions of interest (ROIs) at predefined areas in artifact-free and artifact-affected areas. Measurements were performed in conventional polyenergetic images (CIs) and the corresponding data for VMIs were retrieved through spectral diagrams for the each ROI. Subjective analysis was performed by visual grading of CIs and specific VMIs by two neuroradiologists, independently. Results In artefact-affected image areas distal from the metal objects, the attenuation values decreased with higher energy level VMIs. The same effect was not seen for artefact-affected image areas close to the metal.Subjective rating of the artefact severity was significantly better in VMIs at 50 keV for one of the two reviewers compared to the CIs. Overall image quality and tissue differentiation scores were significantly higher for both reviewers in VMIs at 60 and 70 keV compared to CIs. Conclusion Our quantitative and qualitative image analysis shown that there is a small significant reduction of intracranial coils artifacts severity by all monoenergetic reconstructions from 50 to 200 keV with preserved or increased overall subjective image quality compared to conventional images.
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Key Words
- Aneurysm
- CIs, conventional images
- CSF, cerebrospinal fluid
- CT, computed tomography
- DECT, dual energy computed tomography
- DLP, dose length product
- DSA, digital subtraction angiography
- Diagnostic imaging
- HU, Hounsfield units
- IQR, interquartile range
- MRI, magnetic resonance imaging
- Metal artifacts
- Monoenergetic imaging
- PACS, Picture Archiving and Communication System
- ROI, region of interest
- SD, standard deviation
- SNR, signal-to-noise ratio
- VMIs, virtual monoenergetic images
- WM, white matter
- X-ray computed tomography
- keV, kiloelectron volt
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21
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Taqueti VR, Shah AM, Everett BM, Pradhan AD, Piazza G, Bibbo C, Hainer J, Morgan V, Carolina do A. H. de Souza A, Skali H, Blankstein R, Dorbala S, Goldhaber SZ, Le May MR, Chow BJ, deKemp RA, Hage FG, Beanlands RS, Libby P, Glynn RJ, Solomon SD, Ridker PM, Di Carli MF. Coronary Flow Reserve, Inflammation, and Myocardial Strain: The CIRT-CFR Trial. JACC Basic Transl Sci 2023; 8:141-151. [PMID: 36908662 PMCID: PMC9998473 DOI: 10.1016/j.jacbts.2022.08.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2022] [Accepted: 08/17/2022] [Indexed: 12/24/2022]
Abstract
Inflammation is a key determinant of cardiovascular outcomes, but its role in heart failure is uncertain. In patients with cardiometabolic disease enrolled in the prospective, multicenter ancillary study of CIRT (Cardiovascular Inflammation Reduction Trial), CIRT-CFR (Coronary Flow Reserve to Assess Cardiovascular Inflammation), impaired coronary flow reserve was independently associated with increased inflammation and myocardial strain despite well-controlled lipid, glycemic, and hemodynamic profiles. Inflammation modified the relationship between CFR and myocardial strain, disrupting the association between cardiac blood flow and function. Future studies are needed to investigate whether an early inflammation-mediated reduction in CFR capturing microvascular ischemia may lead to heart failure in patients with cardiometabolic disease. (Cardiovascular Inflammation Reduction Trial [CIRT]; NCT01594333; Coronary Flow Reserve to Assess Cardiovascular Inflammation [CIRT-CFR]; NCT02786134).
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Key Words
- BMI, body mass index
- CAD, coronary artery disease
- CFR, coronary flow reserve
- CT, computed tomography
- GLS, global longitudinal strain
- HDL, high-density lipoprotein cholesterol
- HFpEF, heart failure with preserved ejection fraction
- IL, interleukin
- LDL, low-density lipoprotein cholesterol
- LDM, low-dose methotrexate
- LVEF, left ventricular ejection fraction
- MBF, myocardial blood flow
- MI, myocardial infarction
- NHLBI, National Heart, Lung, and Blood Institute
- NT-proBNP, N-terminal pro–B-type natriuretic peptide
- PET, positron emission tomography
- cardiometabolic disease
- cardiovascular trial coronary flow reserve
- coronary microvascular dysfunction
- heart failure
- hsCRP, high-sensitivity C-reactive protein
- hsTNT, high-sensitivity troponin T
- inflammation
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Affiliation(s)
- Viviany R. Taqueti
- Cardiovascular Imaging Program, Departments of Medicine and Radiology, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts, USA
- Division of Cardiovascular Medicine, Department of Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Amil M. Shah
- Cardiovascular Imaging Program, Departments of Medicine and Radiology, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts, USA
- Division of Cardiovascular Medicine, Department of Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Brendan M. Everett
- Division of Cardiovascular Medicine, Department of Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts, USA
- Center for Cardiovascular Disease Prevention, Division of Preventive Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Aruna D. Pradhan
- Division of Cardiovascular Medicine, Department of Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts, USA
- Center for Cardiovascular Disease Prevention, Division of Preventive Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Gregory Piazza
- Division of Cardiovascular Medicine, Department of Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Courtney Bibbo
- Cardiovascular Imaging Program, Departments of Medicine and Radiology, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Jon Hainer
- Cardiovascular Imaging Program, Departments of Medicine and Radiology, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Victoria Morgan
- Cardiovascular Imaging Program, Departments of Medicine and Radiology, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Ana Carolina do A. H. de Souza
- Cardiovascular Imaging Program, Departments of Medicine and Radiology, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Hicham Skali
- Cardiovascular Imaging Program, Departments of Medicine and Radiology, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts, USA
- Division of Cardiovascular Medicine, Department of Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Ron Blankstein
- Cardiovascular Imaging Program, Departments of Medicine and Radiology, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts, USA
- Division of Cardiovascular Medicine, Department of Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Sharmila Dorbala
- Cardiovascular Imaging Program, Departments of Medicine and Radiology, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts, USA
- Division of Cardiovascular Medicine, Department of Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Samuel Z. Goldhaber
- Division of Cardiovascular Medicine, Department of Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Michel R. Le May
- Division of Cardiology, University of Ottawa Heart Institute, National Cardiac Positron Emission Tomography (PET) Centre, Ottawa, Canada
| | - Benjamin J.W. Chow
- Division of Cardiology, University of Ottawa Heart Institute, National Cardiac Positron Emission Tomography (PET) Centre, Ottawa, Canada
| | - Robert A. deKemp
- Division of Cardiology, University of Ottawa Heart Institute, National Cardiac Positron Emission Tomography (PET) Centre, Ottawa, Canada
| | - Fadi G. Hage
- Division of Cardiovascular Disease, Department of Medicine, University of Alabama at Birmingham and the Birmingham Veterans Affairs Medical Center, Birmingham, Alabama, USA
| | - Rob S. Beanlands
- Division of Cardiology, University of Ottawa Heart Institute, National Cardiac Positron Emission Tomography (PET) Centre, Ottawa, Canada
| | - Peter Libby
- Center for Cardiovascular Disease Prevention, Division of Preventive Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Robert J. Glynn
- Center for Cardiovascular Disease Prevention, Division of Preventive Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Scott D. Solomon
- Cardiovascular Imaging Program, Departments of Medicine and Radiology, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts, USA
- Division of Cardiovascular Medicine, Department of Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Paul M. Ridker
- Division of Cardiovascular Medicine, Department of Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts, USA
- Center for Cardiovascular Disease Prevention, Division of Preventive Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Marcelo F. Di Carli
- Cardiovascular Imaging Program, Departments of Medicine and Radiology, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts, USA
- Division of Cardiovascular Medicine, Department of Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts, USA
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Finsterer J, Mehri S. Let's not blame cocaine as a cause of rhabdomyolysis until all other causes have been ruled out. Radiol Case Rep 2023; 18:727-728. [PMID: 36588596 PMCID: PMC9795243 DOI: 10.1016/j.radcr.2022.11.035] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2022] [Accepted: 11/11/2022] [Indexed: 12/12/2022] Open
Affiliation(s)
- Josef Finsterer
- Neurology & Neurophysiology Center, Postfach 20, Vienna, 1180, Austria
| | - Sounira Mehri
- Biochemistry Laboratory, LR12ES05 "Nutrition-Functional Foods and Vascular Health", Faculty of Medicine, Monastir, Tunisia
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23
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Suwabe T, Ubara Y, Oba Y, Mizuno H, Ikuma D, Yamanouchi M, Sekine A, Tanaka K, Hasegawa E, Hoshino J, Sawa N. Changes in Kidney and Liver Volumes in Patients With Autosomal Dominant Polycystic Kidney Disease Before and After Dialysis Initiation. Mayo Clin Proc Innov Qual Outcomes 2023; 7:69-80. [PMID: 36712823 PMCID: PMC9873948 DOI: 10.1016/j.mayocpiqo.2022.12.005] [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] [Indexed: 01/22/2023] Open
Abstract
Objective To examine the changes in total kidney volume (TKV) and total liver volume (TLV) before and after dialysis initiation in patients with autosomal dominant polycystic kidney disease. Patients and Methods This was a retrospective, single-center cohort study to investigate the changes in TKV and TLV before and after dialysis initiation, along with influencing factors, using linear mixed models. We enrolled 95 patients with autosomal dominant polycystic kidney disease (85 receiving hemodialysis [HD] and 10 receiving peritoneal dialysis [PD]) who began receiving dialysis at Toranomon Hospital from January 1, 2008, to December 31, 2020. Results The least squares mean TKV ratio (TKV at each time point/TKV at dialysis initiation) was 63.8% (95% confidence interval [CI], 54.7%-72.9%) at 6 years before dialysis initiation and 95.5% (95% CI, 82.9%-108.2%) at 6 years after dialysis initiation (P<.001). A multivariate linear mixed model analysis revealed that dialysis style (HD or PD) had the strongest effect on changes in TKV (P=.002). The least squares mean TLV ratio was 98.2% (95% CI, 88.4%-108.0%) at 6 years before dialysis initiation and 95.7% (95% CI, 85.2%-106.2%) at 6 years after dialysis initiation (P=.01). Although PD did not have significant effects on changes in TLV (P=.27), the changes in TLV were greater in patients on PD than in those on HD. Conclusion The TKV increased until dialysis initiation and generally decreased after dialysis initiation. The TLV continued to increase even after dialysis initiation, however, changes in the TLV significantly decreased after dialysis initiation. The increases in TKV and TLV were greater in patients on PD than in those on HD.
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Key Words
- ACDK, acquired cystic disease of the kidney
- ADPKD, autosomal dominant polycystic kidney disease
- ALB, albumin
- BMI, body mass index
- BP, blood pressure
- CI, confidence interval
- CT, computed tomography
- ESKD, end-stage kidney disease
- HD, hemodialysis
- HR, heart rate
- MRI, magnetic resonance imaging
- PD, peritoneal dialysis
- PKD, polycystic kidney disease
- PLD, polycystic liver disease
- TAE, transcatheter arterial embolization
- TKV, total kidney volume
- TLV, total liver volume
- UN, urea nitrogen
- eGFR, estimated glomerular filtration rate
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Affiliation(s)
- Tatsuya Suwabe
- Department of Nephrology, Toranomon Hospital, Tokyo and Kawasaki, Japan,Okinaka Memorial Institute for Medical Research, Toranomon Hospital, Tokyo, Japan,Correspondence: Address to Tatsuya Suwabe, MD, MSc, PhD, Department of Nephrology, Toranomon Hospital, Kajigaya, 1-3-1 Kajigaya, Takatsu, Kawasaki, Kanagawa 213-0015, Japan.
| | - Yoshifumi Ubara
- Department of Nephrology, Toranomon Hospital, Tokyo and Kawasaki, Japan,Okinaka Memorial Institute for Medical Research, Toranomon Hospital, Tokyo, Japan
| | - Yuki Oba
- Department of Nephrology, Toranomon Hospital, Tokyo and Kawasaki, Japan
| | - Hiroki Mizuno
- Department of Nephrology, Toranomon Hospital, Tokyo and Kawasaki, Japan
| | - Daisuke Ikuma
- Department of Nephrology, Toranomon Hospital, Tokyo and Kawasaki, Japan
| | - Masayuki Yamanouchi
- Department of Nephrology, Toranomon Hospital, Tokyo and Kawasaki, Japan,Okinaka Memorial Institute for Medical Research, Toranomon Hospital, Tokyo, Japan
| | - Akinari Sekine
- Department of Nephrology, Toranomon Hospital, Tokyo and Kawasaki, Japan
| | - Kiho Tanaka
- Department of Nephrology, Toranomon Hospital, Tokyo and Kawasaki, Japan
| | - Eiko Hasegawa
- Department of Nephrology, Toranomon Hospital, Tokyo and Kawasaki, Japan
| | - Junichi Hoshino
- Department of Nephrology, Toranomon Hospital, Tokyo and Kawasaki, Japan,Okinaka Memorial Institute for Medical Research, Toranomon Hospital, Tokyo, Japan,Department of Nephrology, Tokyo Women’s Medical University, Tokyo, Japan
| | - Naoki Sawa
- Department of Nephrology, Toranomon Hospital, Tokyo and Kawasaki, Japan,Okinaka Memorial Institute for Medical Research, Toranomon Hospital, Tokyo, Japan
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Kimura T, Takeda Y, Ichi S. Modified extradural selective anterior clinoidectomy leaving the optic canal unopened for internal carotid aneurysms: A technical note. World Neurosurg X 2023; 18:100154. [PMID: 36785622 PMCID: PMC9918798 DOI: 10.1016/j.wnsx.2023.100154] [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: 09/14/2022] [Accepted: 01/10/2023] [Indexed: 01/21/2023] Open
Abstract
Background Anterior clinoidectomy is an established procedure used to decompress the optic nerve, mobilize the internal carotid artery (ICA), or enlarge the retrocarotid space. However, its use carries the risk of optic nerve injury. In certain surgeries, such as those for internal carotid aneurysms, propose modification to the anterior clinoidectomy for enlarging the retrocarotid space, especially in operations for ICA aneurysms. Methods After the anterior clinoid process (ACP) is sufficiently exposed, the internal cancellous bone or pneumatization can be removed through a small window created at its lateral edge to reveal the compact bone of the optic canal. Since the compact bone of the inferior surface facing the ICA is absent or very thin, the ACP can be removed by drilling through the anchoring compact bone with the optic canal in direct sight. Results In 10 consecutive internal carotid aneurysm cases, the ACP was successfully removed without opening of the optic canal to enlarge the retrocarotid space. Conclusions Anterior clinoidectomy can be performed to enlarge the retrocarotid space without opening the optic canal from outside the dura.
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Affiliation(s)
- Toshikazu Kimura
- Corresponding author. Department of Neurosurgery, Japanese Red Cross Medical Center 4-1-22 Hiroo, Shibuya City, Tokyo 150-8935, Japan.
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25
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Keijzer K, Niezink AG, de Boer JW, van Doesum JA, Noordzij W, van Meerten T, van Dijk LV. Semi-automated 18F-FDG PET segmentation methods for tumor volume determination in Non-Hodgkin lymphoma patients: a literature review, implementation and multi-threshold evaluation. Comput Struct Biotechnol J 2023; 21:1102-1114. [PMID: 36789266 PMCID: PMC9900370 DOI: 10.1016/j.csbj.2023.01.023] [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: 11/16/2022] [Revised: 01/18/2023] [Accepted: 01/18/2023] [Indexed: 01/21/2023] Open
Abstract
In the treatment of Non-Hodgkin lymphoma (NHL), multiple therapeutic options are available. Improving outcome predictions are essential to optimize treatment. The metabolic active tumor volume (MATV) has shown to be a prognostic factor in NHL. It is usually retrieved using semi-automated thresholding methods based on standardized uptake values (SUV), calculated from 18F-Fluorodeoxyglucose Positron Emission Tomography (18F-FDG PET) images. However, there is currently no consensus method for NHL. The aim of this study was to review literature on different segmentation methods used, and to evaluate selected methods by using an in house created software tool. A software tool, MUltiple SUV Threshold (MUST)-segmenter was developed where tumor locations are identified by placing seed-points on the PET images, followed by subsequent region growing. Based on a literature review, 9 SUV thresholding methods were selected and MATVs were extracted. The MUST-segmenter was utilized in a cohort of 68 patients with NHL. Differences in MATVs were assessed with paired t-tests, and correlations and distributions figures. High variability and significant differences between the MATVs based on different segmentation methods (p < 0.05) were observed in the NHL patients. Median MATVs ranged from 35 to 211 cc. No consensus for determining MATV is available based on the literature. Using the MUST-segmenter with 9 selected SUV thresholding methods, we demonstrated a large and significant variation in MATVs. Identifying the most optimal segmentation method for patients with NHL is essential to further improve predictions of toxicity, response, and treatment outcomes, which can be facilitated by the MUST-segmenter.
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Key Words
- 18F-FDG PET
- AT, adaptive thresholding methods
- CAR, chimeric antigen receptor
- CT, computed tomography
- DICOM, Digital Imaging and Communications in Medicine
- DLBCL, Diffuse large B-cell lymphoma
- EANM, European Association of Nuclear Medicine
- EARL, EANM Research Ltd.
- FDG, fluorodeoxyglucose
- HL, Hodgkin lymphoma
- IMG, robustness across image reconstruction methods
- IQR, interquartile range
- LBCL, Large B-cell lymphoma
- LDH, lactate dehydrogenase
- MAN, clinician based evaluation using manual segmentations
- MATV, Metabolic active tumor volume
- MIP, Maximum Intensity Projection
- MUST, Multiple SUV Thresholding
- Metabolic tumor volume
- NHL, Non-Hodgkin lymphoma
- Non-Hodgkin lymphoma
- OBS, robustness across observers
- OS, overall survival
- PD-L1, programmed cell death ligand-1
- PET segmentation
- PET, positron emission tomography
- PFS, progression free survival
- PROG, progression vs non-progression
- PTCL, Peripheral T-cell lymphoma
- PTLD, Post-transplant lymphoproliferative disorder
- QS, quality scores
- SOFT, robustness across software
- SUV thresholding
- SUV, standardized uptake value
- Segmentation software
- TCL, T-cell lymphoma
- UMCG, University Medical Center Groningen
- VOI, volume of interest
- cc, cubic centimeter
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Affiliation(s)
- Kylie Keijzer
- Department of Hematology, University Medical Center Groningen, Hanzeplein 1, 9713GZ Groningen, the Netherlands,Department of Radiation Oncology, University Medical Center Groningen, Hanzeplein 1, 9713GZ Groningen, the Netherlands
| | - Anne G.H. Niezink
- Department of Radiation Oncology, University Medical Center Groningen, Hanzeplein 1, 9713GZ Groningen, the Netherlands
| | - Janneke W. de Boer
- Department of Hematology, University Medical Center Groningen, Hanzeplein 1, 9713GZ Groningen, the Netherlands
| | - Jaap A. van Doesum
- Department of Hematology, University Medical Center Groningen, Hanzeplein 1, 9713GZ Groningen, the Netherlands
| | - Walter Noordzij
- Department of Nuclear Medicine and Molecular Imaging, University Medical Center Groningen, Hanzeplein 1, 9713GZ Groningen, the Netherlands
| | - Tom van Meerten
- Department of Hematology, University Medical Center Groningen, Hanzeplein 1, 9713GZ Groningen, the Netherlands
| | - Lisanne V. van Dijk
- Department of Radiation Oncology, University Medical Center Groningen, Hanzeplein 1, 9713GZ Groningen, the Netherlands,Corresponding author.
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Rorris FP, Chatzimichali E, Liverakou E, Antonopoulos CN, Balis E, Kotsifas C, Stratakos G, Koutsoukou A, Zisis C. Tracheal resection in post COVID-19 patients is associated with high reintervention rate and early restenosis. JTCVS Tech 2023; 18:157-163. [PMID: 36685052 PMCID: PMC9846877 DOI: 10.1016/j.xjtc.2023.01.006] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2022] [Revised: 11/21/2022] [Accepted: 12/20/2022] [Indexed: 01/19/2023] Open
Abstract
Objectives A remarkable increase in the number of patients presenting with tracheal complications after prolonged endotracheal intubation and mechanical ventilation for the management of the severe COVID-19 - associated respiratory failure has been observed. In this study, we assessed the postoperative outcomes of tracheal resection in COVID-19 patients. Methods We conducted a retrospective study in which all patients with a history of prolonged invasive mechanical ventilation due to COVID-19 infection, who were treated with tracheal resection and reconstruction, were included. The primary objective was in-hospital mortality and postoperative reintervention rate. The secondary objective was the time to tracheal restenosis. Results During the 16-month study period, 11 COVID-19 patients with tracheal complications underwent tracheal resection with end-to-end anastomosis. Mean patient age was 51.5 ± 9 years, and the majority were male (9 patients). Eight patients were referred for management of post-intubation tracheal stenosis and 3 for tracheoesophageal fistula. Eight patients had a history of tracheostomy during the COVID-19 infection hospitalization. There was one in-hospital death (9.1%) due to septicemia in the Intensive Care Unit, approximately two months after the operation. Postoperatively, 32 reinterventions were required for tracheal restenosis due to granulation tissue formation. The risk for reintervention was higher during the first 3 months after the index operation. Four patients developed tracheal restenosis (36.4%) and two of them required endotracheal stent placement during the follow up period. Conclusions Tracheal resection and reconstruction after COVID-19 infection is associated with a high reintervention rate postoperatively. Such patients require close follow up in expert interventional pulmonology units and physicians should be on high alert for the early diagnosis and optimal management of tracheal restenosis.
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Affiliation(s)
- Filippos-Paschalis Rorris
- Department of Thoracic and Cardiovascular Surgery, Evangelismos General Hospital, Athens, Greece,Address for reprints: Filippos-Paschalis Rorris, MD, Department of Thoracic and Cardiovascular Surgery, Evangelismos General Hospital, Ypsilantou 45-47, Athens, 106 76, Greece
| | - Evangelia Chatzimichali
- Department of Thoracic and Cardiovascular Surgery, Evangelismos General Hospital, Athens, Greece
| | - Evangelia Liverakou
- Department of Thoracic and Cardiovascular Surgery, Evangelismos General Hospital, Athens, Greece
| | - Constantine N. Antonopoulos
- Department of Vascular Surgery, “Attikon” University Hospital, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Evangelos Balis
- Department of Interventional Pulmonology, Evangelismos General Hospital, Athens, Greece
| | - Constantinos Kotsifas
- Department of Interventional Pulmonology, Evangelismos General Hospital, Athens, Greece
| | - Grigoris Stratakos
- Department of Interventional Pulmonology, 1st Department of Pulmonology, Medical School, University of Athens, “Sotiria” Hospital, Athens, Greece
| | - Antonia Koutsoukou
- Department of Interventional Pulmonology, 1st Department of Pulmonology, Medical School, University of Athens, “Sotiria” Hospital, Athens, Greece
| | - Charalampos Zisis
- Department of Thoracic and Cardiovascular Surgery, Evangelismos General Hospital, Athens, Greece
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Takaki T, Murakami S, Tani N, Aoki T. Evaluation of the clinical utility of temporal subtraction using bone suppression processing in digital chest radiography. Heliyon 2023; 9:e13004. [PMID: 36747927 PMCID: PMC9898674 DOI: 10.1016/j.heliyon.2023.e13004] [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: 12/20/2022] [Revised: 01/12/2023] [Accepted: 01/12/2023] [Indexed: 01/19/2023] Open
Abstract
Rationale and objectives To evaluate the usefulness of temporal subtraction using the bone suppression method in digital chest radiography for the detection of pulmonary lesions. Materials and methods The images of 31 patients with pulmonary lesions and 19 normal cases were included in the study. Conventional and bone suppression temporal subtraction were performed in the 50 cases selected and used for an observer performance study. Five radiologists participated in the study, and the differences between using conventional and bone suppression temporal subtraction were assessed using jackknife free-response receiver operating characteristic analysis. Results The average figure-of-merit values for all radiologists increased significantly using the bone suppression method, from 0.619 (conventional) to 0.696 (p = 0.032). The average sensitivity for detecting pulmonary lesions improved from 67.9% to 75.4%, and the average number of false-positive per case decreased from 0.336 to 0.252 using bone suppression temporal subtraction. Conclusion Bone suppression temporal subtraction processing can assist with the detection of subtle pulmonary lesions in digital chest radiographs.
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Affiliation(s)
- Takeshi Takaki
- Department of Radiology, Hospital of University of Occupational and Environmental Health, Iseigaoka 1-1, Yahatanishi-ku, Kitakyushu-shi, Fukuoka, 807-8555, Japan,Corresponding author.
| | - Seiichi Murakami
- Department of Radiological Science, Junshin Gakuen University, 1-1-1 Chikushigaoka, Minami-ku, Fukuoka, 815-8510, Japan
| | - Natsumi Tani
- Department of Radiology, University of Occupational and Environmental Health School of Medicine, Iseigaoka 1-1, Yahatanishi-ku, Kitakyushu-shi, Fukuoka, 807-8555, Japan
| | - Takatoshi Aoki
- Department of Radiology, University of Occupational and Environmental Health School of Medicine, Iseigaoka 1-1, Yahatanishi-ku, Kitakyushu-shi, Fukuoka, 807-8555, Japan
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28
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Gunadi, Prathana S, Amadeus VC, Ramadhita, Iskandar K, Anggraini A. The importance of prenatal diagnosis for the surgical strategy of giant cystic meconium peritonitis: A case report. Heliyon 2023; 9:e12960. [PMID: 36711283 PMCID: PMC9876943 DOI: 10.1016/j.heliyon.2023.e12960] [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: 08/10/2022] [Revised: 12/27/2022] [Accepted: 01/10/2023] [Indexed: 01/17/2023] Open
Abstract
Background Giant cystic meconium peritonitis (MP) is a relatively rare entity. Prompt surgical treatment is required to manage the underlying etiology and reestablish the continuity of the intestines. Despite perinatal and postoperative care improvements, the overall mortality rate is still relatively high. We reported a giant cystic MP that was recognized using antenatal sonography (US). It was successfully treated with primary anastomosis. Case presentation We presented a female newborn with a chief complaint of abdominal mass. The prenatal sonography showed an intraabdominal cyst at the 28th week of gestation. She was born at the gestational age of 38 weeks via vaginal delivery from a primigravid mother without complications, with a birth weight of 3275 g. Elective surgery was performed at the age of eight days, and a calcified 10 cm cyst was revealed along with severe adhesions. The cyst was found to communicate with the ileum located 30 cm proximal from the ileocecal junction. No malrotation and volvulus were found. The cyst and a portion of the ileum were resected, followed by a primary end-to-end anastomosis. Pathologic examination showed necrotic tissue lined with epithelial tissue with microcalcifications containing bilirubin pigments, consistent with cystic MP. The patient has uneventfully discharged on postoperative day 17. The patient has normal growth and development, except for delayed walking, at the last follow-up of two years of age. Conclusion Giant cystic MP is a rare disorder that can be detected early using the antenatal US. Our case highlights the importance of early diagnosis for giant cystic MP using the antenatal US leads to prompt surgical treatment and a more favorable prognosis.
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Affiliation(s)
- Gunadi
- Pediatric Surgery Division, Department of Surgery, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada/Dr. Sardjito Hospital, Yogyakarta 55281, Indonesia,Corresponding author. Pediatric Surgery Division, Department of Surgery, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada/Dr. Sardjito Hospital, Jl. Kesehatan No. 1, Yogyakarta 55281, Indonesia.
| | - Saskia Prathana
- Pediatric Surgery Division, Department of Surgery, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada/Dr. Sardjito Hospital, Yogyakarta 55281, Indonesia
| | - Verrell Christopher Amadeus
- Pediatric Surgery Division, Department of Surgery, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada/Dr. Sardjito Hospital, Yogyakarta 55281, Indonesia
| | - Ramadhita
- Pediatric Surgery Division, Department of Surgery, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada/Dr. Sardjito Hospital, Yogyakarta 55281, Indonesia
| | - Kristy Iskandar
- Department of Child Health, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada/UGM Academic Hospital, Yogyakarta 55291, Indonesia
| | - Alifah Anggraini
- Neonatology Division, Department of Child Health, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada/Dr. Sardjito Hospital, Yogyakarta 55291, Indonesia
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29
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Rott G, Boecker F. Embolization of an incomplete isolated right segmental hepatic duct injury (incomplete IRSHDI)-A case report. Radiol Case Rep 2023; 18:1156-1160. [PMID: 36660564 PMCID: PMC9842957 DOI: 10.1016/j.radcr.2022.12.005] [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: 11/25/2022] [Accepted: 12/04/2022] [Indexed: 01/11/2023] Open
Abstract
Iatrogenic bile duct injuries remain a substantial problem in gastrointestinal surgery, especially if discovered later in the postoperative period. Herein, we report a case of an unusual bile leak following laparoscopic cholecystectomy consisting of an isolated right segmental hepatic duct injury of segment 5 together with an additional bile leak of a small duct connecting the gallbladder fossa with the common bile duct. We call this situation an incomplete isolated right segmental hepatic duct injury. Patient presented with infected biloma 2 weeks after laparoscopic cholecystectomy. After percutaneous drainage of the biloma and antibiotic therapy the complex biliary fistula was closed first with coil embolization of the small connection to the common bile duct and then with both antegrade and retrograde histoacryl embolization of the hereby created complete isolated right segmental hepatic duct injury in a single session. Patient was discharged the same day and recovered without complication or recurrence.
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Affiliation(s)
- Gernot Rott
- Department of Radiology, Bethesda-Hospital, Heerstr. 219, Duisburg, 47053, Germany,Corresponding author.
| | - Frieder Boecker
- Institute of Clinical Radiology, Lukas-Hospital, Neuss, Germany
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30
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Ezzahi M, Zaid E, Farid A, Allali S, Bouardi NE, Haloua M, Hakima A, Alami B, Boubbou M, Maaroufi M, Lamrani MYA. Budd-Chiari syndrome secondary to retro-hepatic vena cava web: An unusual cause of epigastric pain. Radiol Case Rep 2023; 18:1088-1092. [PMID: 36684614 PMCID: PMC9849858 DOI: 10.1016/j.radcr.2022.12.044] [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: 11/23/2022] [Revised: 12/19/2022] [Accepted: 12/20/2022] [Indexed: 01/09/2023] Open
Abstract
Epigastric abdominal pain is a common indication for consultation. In the majority of cases, medical history, clinical examination and routine biological exams allow for an easy diagnosis. Sometimes the symptomatology is unusual, in which case it is essential to perform a complete clinical examination and to use various imaging techniques to search for eventual atypical causes. Membranous obstruction of inferior vena cava is a rare cause of such a phenomenon. We describe a Budd-Chiari syndrome caused by membranous obstruction of inferior vena cava in a 66-year-old woman with no medical history as a rare cause of epigastric abdominal pain. We will describe this clinical experience in the light of the literature and point out the contribution of radiological imaging in the diagnosis of this rare pathology.
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Key Words
- ALP, alkaline phosphatase
- ALT, alanine transaminase
- APS, antiphospholipid syndrome
- AST, aspartate aminotransferase
- Anti-LKM, anti-liver and kidney microsome
- Anti-SLA, anti-soluble liver antigen
- BCS, Budd-Chiari syndrome
- Budd-Chiari
- CT
- CT, computed tomography
- GGT, gamma-glutamyl transferase
- HBc, hepatitis B core
- HBs Ag, hepatitis B surface antigen
- HCV, hepatitis C virus
- IVC, inferior vena cava
- MOIVC
- MOIVC, membranous obstruction of inferior vena cava
- MPS, myeloproliferative syndromes
- MRI, magnetic resonance imaging
- PT, prothrombin time
- Supra-hepatic veins
- TIPS, trans-jugular intra-hepatic portosystemic shunt
- Ultrasound
- Vena cava
- WCC, white count cell
- Web
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Affiliation(s)
- Manar Ezzahi
- Department of Radiology and Interventional Imaging, CHU Hassan II Fez, Sidi Mohammed Ben Abdellah University, Centre Hospitalier Hrazem, BP:1835 Atlas, Fès, Avenue Hassan II, Fez 30050, Morocco,Corresponding author.
| | - Ennasery Zaid
- Department of Radiology and Interventional Imaging, CHU Hassan II Fez, Sidi Mohammed Ben Abdellah University, Centre Hospitalier Hrazem, BP:1835 Atlas, Fès, Avenue Hassan II, Fez 30050, Morocco
| | - Aassouani Farid
- Department of Radiology and Interventional Imaging, CHU Hassan II Fez, Sidi Mohammed Ben Abdellah University, Centre Hospitalier Hrazem, BP:1835 Atlas, Fès, Avenue Hassan II, Fez 30050, Morocco
| | - Soukayna Allali
- Department of Gastro-Hepato-Enterology - CHU Hassan II Fez, Sidi Mohammed Ben Abdellah University, Fez, Morocco
| | - Nizar El Bouardi
- Department of Radiology and Interventional Imaging, CHU Hassan II Fez, Sidi Mohammed Ben Abdellah University, Centre Hospitalier Hrazem, BP:1835 Atlas, Fès, Avenue Hassan II, Fez 30050, Morocco
| | - Meriem Haloua
- Department of Radiology and Interventional Imaging, CHU Hassan II Fez, Sidi Mohammed Ben Abdellah University, Centre Hospitalier Hrazem, BP:1835 Atlas, Fès, Avenue Hassan II, Fez 30050, Morocco
| | - Abid Hakima
- Department of Gastro-Hepato-Enterology - CHU Hassan II Fez, Sidi Mohammed Ben Abdellah University, Fez, Morocco
| | - Badreeddine Alami
- Department of Radiology and Interventional Imaging, CHU Hassan II Fez, Sidi Mohammed Ben Abdellah University, Centre Hospitalier Hrazem, BP:1835 Atlas, Fès, Avenue Hassan II, Fez 30050, Morocco
| | - Meriem Boubbou
- Department of Radiology and Interventional Imaging, CHU Hassan II Fez, Sidi Mohammed Ben Abdellah University, Centre Hospitalier Hrazem, BP:1835 Atlas, Fès, Avenue Hassan II, Fez 30050, Morocco
| | - Mustapha Maaroufi
- Department of Radiology and Interventional Imaging, CHU Hassan II Fez, Sidi Mohammed Ben Abdellah University, Centre Hospitalier Hrazem, BP:1835 Atlas, Fès, Avenue Hassan II, Fez 30050, Morocco
| | - Moulay Youssef Alaoui Lamrani
- Department of Radiology and Interventional Imaging, CHU Hassan II Fez, Sidi Mohammed Ben Abdellah University, Centre Hospitalier Hrazem, BP:1835 Atlas, Fès, Avenue Hassan II, Fez 30050, Morocco
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31
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Zendjebil S, d’Angelo L, Doguet F, Dumont N, Benamer H, Fourchy D, Djebbar M, Garot J, Vaillant R, Garot P. Computed Tomography/Fluoroscopy Fusion and 3D Transesophageal Echocardiography-Guided Percutaneous Paravalvular Leak Closure. JACC Case Rep 2023; 5:101690. [PMID: 36636511 PMCID: PMC9830464 DOI: 10.1016/j.jaccas.2022.101690] [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: 10/11/2022] [Accepted: 10/21/2022] [Indexed: 06/17/2023]
Abstract
Percutaneous paravalvular leak closure seems a safe alternative to surgery in frail patients. However, it is a challenging procedure that should be tailored to each patient with optimal imaging guidance. Transesophageal echocardiography during the procedure and computed tomography scan/fluoroscopy fusion provide guidance for critical steps, such as PVL localization and crossing. (Level of Difficulty: Advanced.).
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Affiliation(s)
- Sandra Zendjebil
- Institut Cardiovasculaire Paris-Sud (ICPS), Hôpital Jacques Cartier, Ramsay-Santé, Massy, France
| | - Livio d’Angelo
- Institut Cardiovasculaire Paris-Sud (ICPS), Hôpital Jacques Cartier, Ramsay-Santé, Massy, France
| | - Fabien Doguet
- Institut Cardiovasculaire Paris-Sud (ICPS), Hôpital Jacques Cartier, Ramsay-Santé, Massy, France
| | | | - Hakim Benamer
- Institut Cardiovasculaire Paris-Sud (ICPS), Hôpital Jacques Cartier, Ramsay-Santé, Massy, France
| | - Dominique Fourchy
- Institut Cardiovasculaire Paris-Sud (ICPS), Hôpital Jacques Cartier, Ramsay-Santé, Massy, France
| | - Morad Djebbar
- Institut Cardiovasculaire Paris-Sud (ICPS), Hôpital Jacques Cartier, Ramsay-Santé, Massy, France
| | - Jérome Garot
- Institut Cardiovasculaire Paris-Sud (ICPS), Hôpital Jacques Cartier, Ramsay-Santé, Massy, France
| | | | - Philippe Garot
- Institut Cardiovasculaire Paris-Sud (ICPS), Hôpital Jacques Cartier, Ramsay-Santé, Massy, France
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32
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Manevich L, Landes U, Gluzman Y, Welt M, Rubinshtein R, Danenberg HD. Thoracic Aorta Perforation Treated Conservatively After TAVR in a Patient With Extremely Tortuous Aorta. JACC Case Rep 2023; 5:101691. [PMID: 36523949 PMCID: PMC9745652 DOI: 10.1016/j.jaccas.2022.101691] [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: 08/25/2022] [Accepted: 09/05/2022] [Indexed: 06/17/2023]
Abstract
Aortic perforation is a rare complication of transcatheter aortic valve replacement associated with grim outcomes. Tortuous and calcified aortas increase the risk of aortic trauma and perforation. We report a case in which, despite massive thoracic bleeding, avoidance of thoracic aortic surgery resulted in clinical recovery. (Level of Difficulty: Intermediate.).
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Affiliation(s)
- Lisa Manevich
- Address for correspondence: Dr Lisa Manevich, Department of Cardiology, E. Wolfson Medical Center, Holon and Tel-Aviv University, Tel-Aviv 5822012, Israel.
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Chiew K, Akhtar M, McGarvey M, Browne S, Vazir A, Heng EL, Smith R. Paradoxical Left-to-Right Device Embolization Complicating Transcatheter Mitral Valve Edge-to-Edge Repair. JACC Case Rep 2023; 5:101692. [PMID: 36523951 PMCID: PMC9745655 DOI: 10.1016/j.jaccas.2022.101692] [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: 08/14/2022] [Revised: 10/18/2022] [Accepted: 10/31/2022] [Indexed: 06/17/2023]
Abstract
We describe an unusual presentation of transcatheter mitral valve edge-to-edge repair device embolization into the left common femoral vein in a patient with primary degenerative mitral regurgitation. We hypothesize a possible mechanism for this phenomenon, factors that may increase the risk of this complication, and outline the patient's clinical course. (Level of Difficulty: Intermediate.).
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Affiliation(s)
- Kayla Chiew
- Address for correspondence: Dr Kayla Chiew, Royal Brompton Hospital, Sydney Street, SW3 6NP London, United Kingdom.
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Kunimoto M, Inomata M, Chin H, Ito Y, Fujimoto K, Muto Y, Nomura M, Sato K, Sakamoto K, Awano N, Kuse N, Kumasaka T, Takemura T, Izumo T. Adult T-cell leukemia/lymphoma complicated by Pneumocystis pneumonia in a non-endemic area. Respir Med Case Rep 2023; 42:101807. [PMID: 36660069 DOI: 10.1016/j.rmcr.2023.101807] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2022] [Revised: 12/20/2022] [Accepted: 01/03/2023] [Indexed: 01/06/2023] Open
Abstract
Adult T-cell leukemia/lymphoma (ATLL) is a human T-cell leukemia virus type 1-inducing unevenly-distributed T-cell malignancy, which is often complicated by opportunistic infections. Here, we discuss the case of a 75-year-old woman presenting with Pneumocystis pneumonia (PCP) who was subsequently diagnosed with ATLL in Tokyo, a non-endemic area of ATLL. In addition to the elevated soluble interleukin-2 receptor and the detection of flower cells in the screening blood test, the high-resolution computed tomography findings, atypical of PCP, were clues to the diagnosis of ATLL. ATLL should be considered as an underlying disease when patients present with PCP, even in non-endemic areas.
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Zou M, Duan X, Li M, Sun J. Accelerated rehabilitation in treating neer type V distal clavicle fractures using anatomical locking plates with coracoclavicular ligament augmentation. Heliyon 2023; 9:e12660. [PMID: 36632103 PMCID: PMC9826830 DOI: 10.1016/j.heliyon.2022.e12660] [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: 09/19/2022] [Revised: 11/23/2022] [Accepted: 12/20/2022] [Indexed: 01/05/2023] Open
Abstract
Background There is still no gold standard treatment for Neer type V distal clavicle fractures. This study was designed to evaluate the therapeutic effects of accelerated rehabilitation in treating Neer type V fractures using anatomical locking plate (ALP) fixation with additional coracoclavicular (CC) ligament augmentation. Methods In this retrospective study, patients who underwent ALP fixation with additional suture anchor fixation of acute Neer type V distal clavicle fracture from January 2016 to January 2021 were reviewed. Injury radiography and computed tomography (CT) were performed to determine the Neer classification. All patients performed standardized early rehabilitation exercises after surgery and were followed up for more than 12 months. The Constant-Murley score (CMS); the disabilities of the arm, shoulder, and hand (DASH) questionnaire; visual analog scale (VAS); and the percentage of modified CC distance (MCCD%) were evaluated at the last follow-up. Results Thirty-two patients were included in this study. The mean follow-up time was 31.1 ± 10.4 months. All patients achieved bone union 6-8 weeks (7.2 ± 0.7 weeks) after surgery and were allowed to return to normal daily life. No surgery-related complications occurred in any case. The MCCD% value at the last follow-up (104.7% ± 8.5%) significantly decreased compared with preoperative MCCD% value (162.8% ± 7.2%) (p < 0.001), indicating that all patients achieved ideal fracture reduction. And all patients obtained satisfactory shoulder joint function with a mean CMS of 97.1 ± 2.6, a mean DASH score of 1.6 ± 1.3, and a mean VAS score of 0.4 ± 0.6. Conclusion This study has demonstrated that ALP fixation with additional suture anchor fixation is a promising strategy for accelerated rehabilitation in treating patients with Neer type V fracture.
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Key Words
- ALP, anatomical locking plate
- Accelerated rehabilitation
- Anatomical locking plate
- CC, coracoclavicular
- CMS, Constant–Murley score
- CT, computed tomography
- Coracoclavicular ligament augmentation
- DASH, the disabilities of the arm, shoulder, and hand
- Distal clavicle fracture
- ERAS, enhanced recovery after surgery
- MCCD%, the percentage of modified CC distance
- Suture anchor fixation
- VAS, visual analog scale
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Affiliation(s)
- Min Zou
- Department of Orthopedics, Chengdu Second People's Hospital, Chengdu, 610021, PR China
| | - Xin Duan
- Department of Orthopedics, No. 1 People's Hospital of Chengdu, Chengdu, 610095, PR China
| | - Mufan Li
- Department of Orthopedics, Chengdu Second People's Hospital, Chengdu, 610021, PR China
| | - Jiachen Sun
- Department of Orthopaedic Surgery, Zhongda Hospital, School of Medicine, Southeast University, Nanjing, 210009, PR China
- Corresponding author. Department of Orthopaedic Surgery, Zhongda Hospital, School of Medicine, Southeast University, No. 87 Dingjiaqiao, Nanjing, 210009, Jiangsu Province, PR China.
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Manja K, Matjaz H, Jus K, Katja AJ, Marko S, Mateja L. Native valve Aspergillus fumigatus endocarditis in a patient with autoimmune hepatitis on low dose systemic corticosteroids: A case report. IDCases 2023; 31:e01728. [PMID: 36911870 PMCID: PMC9996348 DOI: 10.1016/j.idcr.2023.e01728] [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: 01/03/2023] [Revised: 02/17/2023] [Accepted: 02/27/2023] [Indexed: 03/05/2023] Open
Abstract
Aspergillus infectious endocarditis (IE) is a rare cause of culture-negative endocarditis. The main risk factors are severe immunosuppression and prosthetic heart valve. We describe a case of Aspergillus fumigatus IE on a native mitral valve in a patient with autoimmune hepatitis in remission while on low dose corticosteroids. The case is unique due to the patients' low initial risk for invasive fungal disease, its clinical presentation and successful management with emergency surgery and antifungal therapy. After literature review we have not found a similar case report. The patient presented with right-sided eyesight deterioration due to endophthalmitis. Vitrectomy was performed and Aspergillus fumigatus grew on culture. IE on a native mitral valve was confirmed with echocardiography. The patient developed signs of acute heart failure soon after hospital admission and was diagnosed with several septic emboli (kidney, spleen, thumb, right common femoral artery). He was initially treated with surgical valve replacement, dual antifungal therapy with liposomal amphotericin B (LAmB) and voriconazole and vitrectomy, including intravitreal amphotericin B application. Long-term triazole therapy was not possible due to hepatotoxicity. The patient was maintained on intermittent LAmB for 12 months and is without signs of recurrence ten months after therapy was discontinued. Aspergillus can cause invasive infection in patients with autoimmune hepatitis on low dose corticosteroids. Early diagnosis followed by emergency surgical valve replacement and systemic antifungal therapy can improve prognosis. Additional studies are needed to evaluate alternative methods and duration of antimicrobial therapy following Aspergillus IE.
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Affiliation(s)
- Kordis Manja
- Clinic of Infectious Diseases and Febrile Illnesses, University Medical Center Ljubljana, Japljeva 2, 1000 Ljubljana, Slovenia
| | - Hafner Matjaz
- Department of Gastroenterology, University Medical Center Ljubljana, Japljeva 2, 1000 Ljubljana, Slovenia
| | - Ksela Jus
- Department of Cardiovascular Surgery, University Medical Center Ljubljana, Zaloska 2, 1000 Ljubljana, Slovenia.,Faculty of Medicine, University of Ljubljana, Vrazov trg 2, 1000 Ljubljana, Slovenia
| | - Azman Juvan Katja
- Department of Cardiovascular Surgery, University Medical Center Ljubljana, Zaloska 2, 1000 Ljubljana, Slovenia
| | - Sulak Marko
- Department of Ophthalmology, University Medical Center Ljubljana, Zaloska 2, 1000 Ljubljana, Slovenia
| | - Logar Mateja
- Clinic of Infectious Diseases and Febrile Illnesses, University Medical Center Ljubljana, Japljeva 2, 1000 Ljubljana, Slovenia.,Faculty of Medicine, University of Ljubljana, Vrazov trg 2, 1000 Ljubljana, Slovenia
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Almofada HS, Almutairi NK, Timms MS. Long-term complications of the transmeatal approach (Open Transcanal) in cochlear implants: A follow-up study. J Otol 2023; 18:33-37. [PMID: 36820154 PMCID: PMC9937834 DOI: 10.1016/j.joto.2022.12.002] [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: 07/07/2022] [Revised: 11/01/2022] [Accepted: 12/13/2022] [Indexed: 12/23/2022] Open
Abstract
Objective Multiple alternative approaches of cochlear implant surgery have been described, such as the suprameatal approach, transcanal approach, transmeatal approach and middle cranial fossa approach. Transmeatal (open trnascanal) approach has not been adapted since first described in the clinical field. we aimed to assess the long-term complications of the transmeatal approach in a series of 131 patients at our center between 2004 and 2008. Methods This study was a retrospective case series of all patients who underwent cochlear implants with the transmeatal (open transcanal) approach from May 2004 to December 2008 at King Faisal Specialist and Research Hospital (Riyadh, Saudi Arabia), which were conducted by the same surgeon. Results Complications were observed often with various combinations-recurrent otitis externa, posterior tympanic membrane perforation, electrode extrusion, cholesteatoma, and chronic mastoiditis. The overall long-term complication rate was 16% (21/131). The gap between the implantation and the diagnosis of a complication ranged from <1 year to 11 years. Major complications were as follows: cholesteatoma in 5 (3.8%) patients, extrusion of the electrode in 5 (3.8%) patients, and tympanic membrane perforation or deep retractions in 5 (3.8%) patients. Minor complications were as follows: recurrent mastoiditis with/without concomitant temporary facial nerve palsy in 4 (3%) patients, recurrent otitis externa infections in 7 (5%) patients, and weakness of the posterior canal wall in 1 patient. Conclusion The transmeatal approach posed an high rate of complications on long-term follow-up such as cholestetoma formation, extrusion of electrode or perielectrode reaction formation to tympanic membrane and external auditory canal.
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Affiliation(s)
- Hesham Saleh Almofada
- King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
- Al Faisal University, College of Medicine, Saudi Arabia
- Corresponding author.King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia.
| | - Nasser K. Almutairi
- King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
- Al Faisal University, College of Medicine, Saudi Arabia
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Young D, Mei A, Mahbub E, Grees A, Lachhar G, D'Souza K, Perwaiz M. Recurrent chylothorax as a consequence of esophageal stent. Respir Med Case Rep 2023; 43:101827. [PMID: 36950024 PMCID: PMC10025268 DOI: 10.1016/j.rmcr.2023.101827] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2022] [Revised: 12/24/2022] [Accepted: 03/02/2023] [Indexed: 03/12/2023] Open
Abstract
Incidence of chylothorax post-esophageal stenting has not been reported. We present a 40-year-old female with metastatic breast cancer who presented with dyspnea. She was recently hospitalized for dysphagia secondary to a mediastinal mass requiring an esophageal stent. CT chest now reported large bilateral pleural effusions. A benign chylothorax was drained from the right side. After persistent high-output drainage, a review of her CT chest revealed thoracic duct impingement by the esophageal stent. The stent was retracted proximally, and pleural fluid output subsequently decreased. Repeat fluid analysis revealed a transudative effusion. This is the first reported case of esophageal stenting causing reversible chylothorax.
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Affiliation(s)
- Daisy Young
- Fellow of Pulmonary and Critical Care Medicine, Icahn School of Medicine at Mount Sinai, Elmhurst Hospital Center, 79-01 Broadway, Elmhurst, NY, 11373, USA
- Corresponding author. 79-01 Broadway, Elmhurst, NY, 11373, USA.
| | - Alice Mei
- Stony Brook Southampton Hospital, 240 Meeting House Lane, Southampton, NY, 11968, USA
| | - Elnaz Mahbub
- Stony Brook Southampton Hospital, 240 Meeting House Lane, Southampton, NY, 11968, USA
| | - Andrew Grees
- Stony Brook Southampton Hospital, 240 Meeting House Lane, Southampton, NY, 11968, USA
| | - Garry Lachhar
- Stony Brook Southampton Hospital, 240 Meeting House Lane, Southampton, NY, 11968, USA
| | - Kenneth D'Souza
- Fellow of Pulmonary and Critical Care Medicine, Icahn School of Medicine at Mount Sinai, Elmhurst Hospital Center, 79-01 Broadway, Elmhurst, NY, 11373, USA
| | - Muhammad Perwaiz
- Icahn School of Medicine at Mount Sinai, Elmhurst Hospital Center, 79-01 Broadway, Elmhurst, NY, 11373, USA
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Kato D, Takegami Y, Seki T, Osawa Y, Takemoto G, Okamoto M, Iida H, Imagama S. Differences in peri-hip articular pain after total hip arthroplasty between taper wedge stem and fit-and-fill stem. J Orthop 2023; 35:58-63. [PMID: 36387764 PMCID: PMC9661431 DOI: 10.1016/j.jor.2022.10.014] [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] [Received: 10/04/2022] [Revised: 10/24/2022] [Accepted: 10/27/2022] [Indexed: 11/06/2022] Open
Abstract
Background Total hip arthroplasty (THA) for hip disorders helps to alleviate pain and improve active daily life. When determining the effects of medical therapy and the subsequent clinical results, patient quality of life (QOL) also needs to be assessed. Recently, patient-reported outcomes (PRO) have become important as evaluation criteria. This study aimed to evaluate patient QOL and various PRO between different types of cementless stems and to clarify the relationship between PRO and stem-cortical bone contact. Methods The study comprised 138 consecutive patients undergoing cementless THA for hip osteoarthritis. We assessed three different types of PRO: the Japanese Orthopaedic Association Hip-Disease Evaluation Questionnaire (JHEQ), patient's joint perception, and peri-hip articular joint pain (PHAP). We measured the state of contact between femur and implant by density mapping. Results No significant difference was noted in PRO between stem types based on the JHEQ and patient's joint perception. PHAP occurred more frequently in the patients with a taper wedge stem versus a fit-and-fill stem. In both groups, distal contact was associated with PHAP but not with JHEQ results and patient's joint perception. Conclusion The difference in PHAP between the two stem types groups was significant, with postoperative PHAP being higher with the taper wedge stem because of the more distal contact between the taper wedge stem and femur cortical bone.
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Affiliation(s)
- Daisaku Kato
- Department of Orthopaedic Surgery, Nagoya University Graduate School of Medicine, 65 Tsurumai, Showa-ku, Nagoya, 466-8550, Japan
| | - Yasuhiko Takegami
- Department of Orthopaedic Surgery, Nagoya University Graduate School of Medicine, 65 Tsurumai, Showa-ku, Nagoya, 466-8550, Japan
| | - Taisuke Seki
- Department of Orthopaedic Surgery, Nagoya University Graduate School of Medicine, 65 Tsurumai, Showa-ku, Nagoya, 466-8550, Japan
| | - Yusuke Osawa
- Department of Orthopaedic Surgery, Nagoya University Graduate School of Medicine, 65 Tsurumai, Showa-ku, Nagoya, 466-8550, Japan
| | - Genta Takemoto
- Department of Orthopaedic Surgery, Nagoya University Graduate School of Medicine, 65 Tsurumai, Showa-ku, Nagoya, 466-8550, Japan
| | - Masanori Okamoto
- Department of Orthopaedic Surgery, Nagoya University Graduate School of Medicine, 65 Tsurumai, Showa-ku, Nagoya, 466-8550, Japan
| | - Hiroki Iida
- Department of Orthopaedic Surgery, Nagoya University Graduate School of Medicine, 65 Tsurumai, Showa-ku, Nagoya, 466-8550, Japan
| | - Shiro Imagama
- Department of Orthopaedic Surgery, Nagoya University Graduate School of Medicine, 65 Tsurumai, Showa-ku, Nagoya, 466-8550, Japan
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Tonne EO, Fosbøl MØ, Poulsen A, Nygaard U, Højgaard L, Borgwardt L. Imaging modalities for pulmonary tuberculosis in children: A systematic review. Eur J Radiol Open 2022; 10:100472. [PMID: 36624819 PMCID: PMC9823145 DOI: 10.1016/j.ejro.2022.100472] [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: 12/15/2022] [Accepted: 12/20/2022] [Indexed: 12/31/2022] Open
Abstract
Purpose The optimal choice of protocol for diagnostic imaging in children with tuberculosis (TB) is a contemporary challenge due to the war in Ukraine, which potentially can create a steep rise in TB cases in Western Europe. We aimed to gather all primary research comparing imaging modalities and their diagnostic accuracies for pulmonary findings in children with suspected or confirmed pulmonary tuberculosis (PTB). Method We searched the databases PubMed and Embase using pre-specified search terms, for English- and non-English published and un-published reports from the period 1972 to 2022. We retrieved reports via citation search in excluded literature reviews and systematic reviews. Studies were eligible if most of the study population was between 0 and 18 years of age with confirmed or suspected PTB, and study participants had described diagnostic images from two or more different imaging modalities. Results A total of 15 studies investigated conventional chest X-Ray (CXR) and computed tomography (CT) in diagnosing PTB in children. Nine studies investigated the number of participants in where CT or CXR confirmed the diagnosis of TB, and all of them, including a total of 1244 patients, reported that findings compatible with TB were more frequently detected on CT than CXR. Only two studies did not include radiological findings as part of their diagnostic criteria for PTB, and combined they showed that CT diagnosed 54/54 (100 %) children with confirmed PTB, while CXR diagnosed 42/54 (78 %). Two studies compared magnetic resonance imaging (MRI) with CXR and showed that MRI diagnosed more children with PTB than CXR. One study reported a higher positive predictive value (PPV), sensitivity and specificity for PTB findings for MRI than CXR. One study compared CXR with high-kilovolt (high-kV) CXR, finding compatible sensitivity and specificity regarding confirmation of PTB. Two studies compared ultrasound (US) with CXR and found that US had a higher diagnostic yield and more often correctly identified consolidations, mediastinal LAP, and pleural effusion. Conclusion CT showed a higher diagnostic accuracy for PTB findings than CXR, MRI and US, and should be the imaging modality of first choice when available. MRI had a higher sensitivity and specificity than CXR for LAP, pleural effusion, and cavitation. US was complimentary in initial diagnostic work-up and follow up. A diagnostic strategy for PTB in children according to local availability and expertise is proposed, as no evidence from this systematic review shows otherwise, in acknowledgement of the expertise in high TB-burdened countries. CT can be performed when in doubt, due to the higher diagnostic yield.
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Key Words
- CT
- CT, computed tomography
- CXR, chest x-ray
- Child
- Diagnostic imaging
- EPTB, extrapulmonary tuberculosis
- LAP, lymphadenopathy
- MRI, magnetic resonance imaging
- NPV, negative predictive value
- PCR, polymerase chain reaction
- PET, positron emission tomography
- PPD, purified protein derivative
- PPV, positive predictive value
- PTB
- PTB, pulmonary tuberculosis
- Pulmonary tuberculosis
- Systematic review
- TB
- TB, tuberculosis
- TST, tuberculin skin test
- US, ultrasound
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Affiliation(s)
- Erle Opdahl Tonne
- Department of Clinical Physiology and Nuclear Medicine, Rigshospitalet, University of Copenhagen, Denmark
| | - Marie Øbro Fosbøl
- Department of Clinical Physiology and Nuclear Medicine, Rigshospitalet, University of Copenhagen, Denmark
- Department of Clinical Physiology and Nuclear Medicine, North Zealand Hospital, Hillerød, Denmark
| | - Anja Poulsen
- Global Health Unit, Department of Paediatrics and Adolescent Medicine, Rigshospitalet, University of Copenhagen, Denmark
- Department of Paediatrics and Adolescent Medicine, Rigshospitalet, University of Copenhagen, Denmark
| | - Ulrikka Nygaard
- Department of Paediatrics and Adolescent Medicine, Rigshospitalet, University of Copenhagen, Denmark
| | - Liselotte Højgaard
- Department of Clinical Physiology and Nuclear Medicine, Rigshospitalet, University of Copenhagen, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Denmark
| | - Lise Borgwardt
- Department of Clinical Physiology and Nuclear Medicine, Rigshospitalet, University of Copenhagen, Denmark
- Corresponding author.
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Perrin N, Bonnet G, Ibrahim R, Bonan R, Leroux L, Granada JF, Tardif JC, Modine T, Ben Ali W. Novel Humanized Biosimulator to Predict Coronary Obstruction in High-Risk Valve-in-Valve Procedures. JACC Case Rep 2022; 7:101711. [PMID: 36776792 PMCID: PMC9911917 DOI: 10.1016/j.jaccas.2022.101711] [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: 08/30/2022] [Revised: 11/04/2022] [Accepted: 11/09/2022] [Indexed: 12/25/2022]
Abstract
We developed humanized biosimulator to predict the risk of coronary obstruction among high-risk patients undergoing valve-in-valve (ViV) procedures. In this case, based on unchanged instantaneous wave-free ratio values measured during a ViV simulation session, the procedure was performed safely in the patient the day afterward, without coronary artery issues and with good hemodynamic results. (Level of Difficulty: Advanced.).
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Affiliation(s)
- Nils Perrin
- Structural Heart Intervention Program, Montreal Heart Institute, Montreal, Quebec, Canada,Cardiology Division, Geneva University Hospitals, Switzerland
| | - Guillaume Bonnet
- Service Médico-Chirurgical: Valvulopathies-Chirurgie Cardiaque-Cardiologie Interventionelle Structurelle, Hôpital Cardiologique de Haut Lévèque, CHU Bordeaux, France
| | - Réda Ibrahim
- Structural Heart Intervention Program, Montreal Heart Institute, Montreal, Quebec, Canada
| | - Raoul Bonan
- Structural Heart Intervention Program, Montreal Heart Institute, Montreal, Quebec, Canada
| | - Lionel Leroux
- Service Médico-Chirurgical: Valvulopathies-Chirurgie Cardiaque-Cardiologie Interventionelle Structurelle, Hôpital Cardiologique de Haut Lévèque, CHU Bordeaux, France
| | | | - Jean Claude Tardif
- Structural Heart Intervention Program, Montreal Heart Institute, Montreal, Quebec, Canada
| | - Thomas Modine
- Service Médico-Chirurgical: Valvulopathies-Chirurgie Cardiaque-Cardiologie Interventionelle Structurelle, Hôpital Cardiologique de Haut Lévèque, CHU Bordeaux, France
| | - Walid Ben Ali
- Structural Heart Intervention Program, Montreal Heart Institute, Montreal, Quebec, Canada,Address for correspondence: Dr. Walid Ben Ali, Montreal Heart Institute, 5000 Belanger Street, Montreal, Quebec H1T 1C8, Canada.
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Takeda Y, Ota K, Kondo A, Nishii T, Onishi N, Yokoyama H, Yamakawa K, Takasu A. A case of necrotizing fasciitis caused by Bifidobacterium breve. IDCases 2022; 31:e01667. [PMID: 36636462 PMCID: PMC9830150 DOI: 10.1016/j.idcr.2022.e01667] [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: 10/01/2022] [Revised: 12/10/2022] [Accepted: 12/19/2022] [Indexed: 12/24/2022] Open
Abstract
Background Bifidobacterium breve is an obligate anaerobic gram-positive bacillus mainly found in the gastrointestinal tract of human infants. Few cases of necrotizing fasciitis caused by B. breve have been reported. Case presentation A 42-year-old Japanese man with type 2 diabetes mellitus, obesity, cellulitis of the back, and subcutaneous abscess of the right inguinal region presented with rapidly developing erythema, swelling and severe pain in the right inguinal region. Computed tomography showed widespread gas in the right leg region. Cultures of blood and a swab of the wound abscess grew gram-positive bacilli. Mass spectrography and 16 S rDNA analysis confirmed the gram-positive bacilli as B. breve. The patient recovered following extensive debridement and antibacterial therapy. Conclusion Unidentified necrotizing fasciitis can be caused by B. breve, especially in compromised hosts.
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Affiliation(s)
| | - Koshi Ota
- Correspondence to: Department of Emergency Medicine, Osaka Medical and Pharmaceutical University, 2-7 Daigaku-machi, Takatsuki City, Osaka 596-8686, Japan.
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Widmann G, Beyer A, Jaschke W, Luger A, Zoller H, Tilg H, Schneeberger S, Wolf D, Gizewski ER, Eder R, Torbica P, Verius M. Identification and characterization of patients being exposed to computed-tomography associated radiation-doses above 100 mSv in a real-life setting. Eur J Radiol Open 2023; 10:100470. [PMID: 36590327 DOI: 10.1016/j.ejro.2022.100470] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2022] [Revised: 12/16/2022] [Accepted: 12/20/2022] [Indexed: 12/24/2022] Open
Abstract
Rationale and objectives Patients receiving high cumulative effective doses (CED) from recurrent computed tomography (CT) in a real-life setting are not well identified. Evaluation of causes and patient characteristics may help to define individuals potentially at risk of radiation-induced secondary malignancies. Materials and methods Patients who received a CED > 100 mSv from CT scans during October 2012 and April 2020 at a tertiary university center were identified with the help of a radiological radiation dose monitoring system. The primary disease and referral diagnosis, number of CT exams, time period, age, BMI and gender distribution of the 1000 patients with the highest CED were analysed. Results 3431 patients had a CED of more than 100 mSv, which corresponded to 2.75% of all patients who received a CT exam. From the 1000 patients with the highest CED, mean number of CT exams per patient was 14.6, mean CED was 257 mSv (SD 98, range 177-1339). Mean age of patients was 63.9 years (SD 10.6), male to female ratio 3:2, and mean BMI 28.7 kg/m2 (SD 5.5). 728 (72.9%) patients had cancer. The leading primary diagnosis was liver cirrhosis in 197 patients and 103 patients had a liver transplantation. In patients with liver cirrhosis, 750 exams were indicated for the follow-up of the disease, 662 for the clarification of an acute clinical condition, and 202 for CT-guided stereotactic radiofrequency ablation. Conclusion Recurrent CT scans of patients with cancer, liver cirrhosis and liver transplantation may lead to critically high CED.
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Dumitrascu AG, Rojas CA, Stancampiano F, Johnson EM, Harris DM, Chirila RM, Omer M, Hata DJ, Meza-Villegas DM, Heckman MG, White LJ, Alvarez S. Invasive Nocardiosis Versus Colonization at a Tertiary Care Center: Clinical and Radiological Characteristics. Mayo Clin Proc Innov Qual Outcomes 2022; 7:20-30. [PMID: 36589733 PMCID: PMC9798119 DOI: 10.1016/j.mayocpiqo.2022.11.002] [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: 12/24/2022] Open
Abstract
Objective To describe the clinical and radiographic findings in a large cohort of patients with positive cultures for Nocardia emphasizing the differences between invasive disease and colonization. Patients and Methods We conducted a single-center, retrospective cohort study of 133 patients with a positive Nocardia isolate between August 1, 1998, and November 30, 2018, and a computed tomography (CT) of the chest within 30 days before or after the bacteria isolation date. Results Patients with colonization were older (71 vs 65 years; P=.004), frequently with chronic obstructive pulmonary disease (56.8% vs 16.9%; P<.001) and coronary artery disease (47.7% vs 27%, P=.021), and had Nocardia isolated exclusively from lung specimens (100% vs 83.1%; P=.003). On CT of the chest, they had frequent airway disease (84.1% vs 51.7%; P<.001). Patients with invasive nocardiosis had significantly (P<.05) more diabetes, chronic kidney disease, solid organ transplant, use of corticosteroids, antirejection drugs, and prophylactic sulfa. They had more fever (25.8% vs 2.3%; P<.001), cutaneous lesions (14.6% vs 0%; P=.005), fatigue (18% vs 0%; P=.001), pulmonary nodules (52.8% vs 27.3%; P=.006), and free-flowing pleural fluid (63.6% vs 29.4%; P=.024). The patterns of nodule distribution were different-diffuse for invasive nocardiosis and peribronchiolar for Nocardia colonization. Conclusion The isolation of Nocardia in sputum from a patient with respiratory symptoms does not equal active infection. Only by combining clinical and chest CT findings, one could better differentiate between invasive nocardiosis and Nocardia colonization.
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Affiliation(s)
- Adrian G. Dumitrascu
- Division of Hospital Internal Medicine, Department of Medicine, Mayo Clinic Florida, Jacksonville, FL,Correspondence: Address to Adrian Dumitrascu, MD, Division of Hospital Internal Medicine, Mayo Clinic, 4500 San Pablo Rd, Jacksonville, FL 32224.
| | - Carlos A. Rojas
- Division of Cardiothoracic Radiology, Department of Radiology, Mayo Clinic Arizona, Scottsdale, AZ
| | - Fernando Stancampiano
- Division of Community Internal Medicine, Department of Medicine, Mayo Clinic Florida, Jacksonville, FL
| | - Elizabeth M. Johnson
- Division of Cardiothoracic Radiology, Department of Radiology, Mayo Clinic Florida, Jacksonville, FL
| | - Dana M. Harris
- Division of Medallion Medicine, Department of Medicine, Mayo Clinic Florida, Jacksonville, FL
| | - Razvan M. Chirila
- Division of International and Executive Medicine, Department of Medicine, Mayo Clinic Florida, Jacksonville, FL
| | - Mohamed Omer
- Division of Internal Medicine, Department of Medicine, Harlem Hospital Center/Columbia University, New York, NY
| | - D. Jane Hata
- Department of Laboratory Medicine and Pathology, Mayo Clinic Florida, Jacksonville, FL
| | | | - Michael G. Heckman
- Division of Clinical Trials and Biostatistics, Department of Quantitative Health Sciences, Mayo Clinic Florida, Jacksonville, FL
| | - Launia J. White
- Division of Clinical Trials and Biostatistics, Department of Quantitative Health Sciences, Mayo Clinic Florida, Jacksonville, FL
| | - Salvador Alvarez
- Division of Infectious Diseases, Department of Medicine, Mayo Clinic Florida, Jacksonville, FL
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Guirgis L, Hascoet S, Van Aerschot I, Radojevic J, Ly M, Cohen S, Belli E. Outcomes after the Ross procedure with pulmonary autograft reinforcement by reimplantation. JTCVS Tech 2023; 17:121-8. [PMID: 36820346 DOI: 10.1016/j.xjtc.2022.11.016] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2022] [Revised: 10/31/2022] [Accepted: 11/14/2022] [Indexed: 12/24/2022] Open
Abstract
Background Pulmonary autograft reinforcement to prevent dilatation and subsequent neo-aortic valve regurgitation has been reported; however, data on long-term function of the neo-aortic valve after this modified Ross procedure are lacking. Our objective here was to assess long-term outcomes of the modified Ross procedure with autograft reinforcement using the reimplantation technique. Patients The outcomes of 61 consecutive patients managed using the Dacron-conduit reinforced Ross procedure between 2009 and 2021 were reviewed. Most patients had a unicuspid or bicuspid aortic valve (n = 52; 85%), predominant aortic valve regurgitation (n = 42; 77%), and >30 mm dilatation of the ascending aorta (n = 33; 54%). A prior aortic valve procedure was noted in 47 patients (77%) patients, including 38 (62%) with surgical repair and 9 (15%) with balloon dilatation. The pulmonary autograft was reimplanted within a Dacron conduit with a median diameter of 25.6 mm (range, 20-30 mm) using the David valve-sparing aortic root replacement technique. Results All patients survived. The median age at surgery was 16.8 years (range, 6-38 years). Neo-aortic valve replacement was required in 3 patients (4.9%; 95% CI, 0.34%- 12.7%) because of infective endocarditis, left ventricular false aneurysm, and leaflet perforation, respectively; the repeat procedure was done early in 2 of these patients (2 of 61; 3%). Six patients required right ventricular outflow conduit replacement, 5 by surgery and 1 percutaneously. The median duration of follow-up was 90 months (range, 10-124 months). The 5- and 10-year rates of reintervention-free survival were 84.3% (95% CI, 74%-95%) and 81.6% (95% CI, 72%-93%), respectively, and 5-year survival without aortic reintervention was 94.5% (95% CI, 88%-100%), with little change at 10 years. No patients experienced deterioration of initial neo-aortic valve function (ie, regurgitation or stenosis). Conclusions Autograft reinforcement using the reimplantation technique allowed expansion of Ross procedure indications to all patients requiring aortic valve replacement and prevented neo-aortic root dilatation. Failures were uncommon. Long-term follow-up data showed stable neo-aortic valve function.
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Higashino N, Kawai N, Sonomura T, Fukuda K, Sato H, Ikoma A, Kawai M, Minamiguchi H. Percutaneous transsplenic venous embolization of elevated jejunal varices after pancreaticoduodenectomy: A case report. Radiol Case Rep 2022; 18:737-740. [PMID: 36582761 PMCID: PMC9792728 DOI: 10.1016/j.radcr.2022.11.053] [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: 11/11/2022] [Accepted: 11/20/2022] [Indexed: 12/23/2022] Open
Abstract
Recent advances in chemotherapy and radiotherapy have led to an increase in the number of long-term survivors of pancreatic cancer. However, this has also increased the number of patients suffering from ectopic varices and bleeding owing to left-sided portal hypertension and thrombocytopenia caused by splenomegaly after pancreaticoduodenectomy combined with resection of the splenic vein. A 65-year-old woman with varices of the elevated jejunum due to left sided portal hypertension after pancreaticoduodenectomy had repeated melena, which started about 1 year before admission. We describe the first reported case of percutaneous transsplenic venous embolization using metallic coils, which successfully achieved hemostasis of refractory bleeding from the elevated jejunal varices after pancreaticoduodenectomy.
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Key Words
- CT, computed tomography
- CTV, computed tomography during venography
- EO, ethanolamine oleate
- Elevated jejunal varices
- LSPH, left-sided portal hypertension
- Left-sided portal hypertension
- PD, pancreaticoduodenectomy
- PSE, partial splenic artery embolization
- PV, portal vein
- Pancreaticoduodenectomy
- Percutaneous transsplenic venous embolization
- SMV, superior mesenteric vein
- STS, sodium tetradecyl sulfate
- SV, splenic vein
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Affiliation(s)
- Nobuyuki Higashino
- Department of Radiology, Wakayama Medical University, 811-1 Kimiidera, Wakayamashi, Wakayama 641-8509, Japan
- Corresponding author.
| | - Nobuyuki Kawai
- Department of Radiology, Wakayama Medical University, 811-1 Kimiidera, Wakayamashi, Wakayama 641-8509, Japan
| | - Tetsuo Sonomura
- Department of Radiology, Wakayama Medical University, 811-1 Kimiidera, Wakayamashi, Wakayama 641-8509, Japan
| | - Kodai Fukuda
- Department of Radiology, Wakayama Medical University, 811-1 Kimiidera, Wakayamashi, Wakayama 641-8509, Japan
| | - Hirotatsu Sato
- Department of Radiology, Wakayama Medical University, 811-1 Kimiidera, Wakayamashi, Wakayama 641-8509, Japan
| | - Akira Ikoma
- Department of Radiology, Wakayama Medical University, 811-1 Kimiidera, Wakayamashi, Wakayama 641-8509, Japan
| | - Manabu Kawai
- Second Department of Surgery, Wakayama Medical University, Wakayama, Japan
| | - Hiroki Minamiguchi
- Department of Radiology, Wakayama Medical University, 811-1 Kimiidera, Wakayamashi, Wakayama 641-8509, Japan
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Tsukamoto H, Kijima H, Saito K, Saito H, Miyakoshi N. Diagnostic accuracy of ultrasonography for occult femoral neck fracture. J Clin Orthop Trauma 2023; 36:102087. [PMID: 36570856 DOI: 10.1016/j.jcot.2022.102087] [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] [Received: 07/26/2022] [Revised: 11/08/2022] [Accepted: 12/12/2022] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND A delay in the diagnosis and treatment of an occult femoral neck fracture (OFNF) can negatively affect the subsequent quality of life. We investigated the diagnostic accuracy of ultrasonography for OFNF in patients confirmed with this condition by magnetic resonance imaging (MRI), and compared these results with other clinical findings. METHODS Ninety-four outpatients aged above 70 years with acute hip pain but without radiographic abnormal findings who were suspected of having an occult femoral neck fracture (11 men and 83 women with a mean age of 81.8 ± 6.0 years) were enrolled. Both ultrasonography and MRI were performed in all cases within 24 h. The ultrasonographic distance between the anterior aspect of the femoral neck and the anterior joint capsule (ultrasound joint swelling) was measured. RESULTS By MRI findings, 27 patients were assigned to an occult femoral neck fracture (OFNF) group (1 man, 26 women) and 67 patients to a non-OFNF group (10 men, 57 women). The mean ultrasound joint swelling in both groups was 7.53 ± 1.52 mm and 3.45 ± 0.89 mm, respectively (p = 0.006, 95% CI, 3.58-4.59). A cut-off value of 5.3 mm showed a sensitivity of 0.96 (0.89-0.96) and a specificity of 0.98 (0.92-1.00). CONCLUSIONS Ultrasonography shows very high diagnostic accuracy for occult femoral neck fracture. This modality can thus contribute to initial bed-side examinations for this condition in patients over 70 years with acute hip pain.
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Key Words
- BHA, bipolar hip arthroplasty
- CT, computed tomography
- Diagnostic accuracy
- Femoral neck fracture
- MRI, magnetic resonance imaging
- NPV, negative predictive value
- OFNF, occult femoral neck fracture
- Occult fracture
- PPV, positive predictive value
- ROC, Receiver operating characteristic ROC
- STIR, short TI inversion recovery
- UJS, ultrasonographic joint swelling
- US, ultrasonography
- Ultrasonography
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Fujita T, Takeya A, Miyata H, Ninomiya F, Nonoyama Y, Nakazawa T, Furuya Y, Enoki Y, Fujii T, Fukao S. Thoracic spinal metastasis as recurrence of borderline Brenner tumor without local recurrence: A case report. Gynecol Oncol Rep 2022; 44:101120. [PMID: 36589509 PMCID: PMC9797606 DOI: 10.1016/j.gore.2022.101120] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2022] [Revised: 11/16/2022] [Accepted: 11/22/2022] [Indexed: 12/15/2022] Open
Abstract
Background Brenner tumor is a rare epithelial ovarian neoplasm that accounts for 2-3% of all ovarian neoplasms. Herein, we report the first case of thoracic spinal metastasis of recurrent Brenner tumor without local recurrence.Case Description.A 70-year-old female presented with a feeling of abdominal distension. Computed tomography revealed cystic lesions in her bilateral ovaries. Blood examination revealed high CA-125 [74.9 U/ml]. We excised bilateral ovaries, uterus, and omentum. Borderline Brenner tumor was diagnosed [Ki-67 labeling index: 10 %]. Follow-up abdominal echo and CA-125 examination revealed no local recurrence. 26 months later she developed paraplegia. Magnetic resonance imaging revealed tumor in the 5th-9th thoracic vertebra and compression of spinal cord at the 6th thoracic vertebra level. Her paraplegia was progressive. We performed semi-urgent partial resection of tumor and release of spinal cord compression. Spinal metastasis from Brenner tumor was diagnosed [Ki-67 labeling index: 50-60 %]. She received adjuvant radiation of 30 Gy in 10 fractions to the 4th-10th thoracic vertebra. After radiation and rehabilitation, she was discharged home on foot. She received adjuvant radiation and chemotherapy but died 11 months after spinal surgery. An autopsy has not been performed on her, and the cause of death is unknown. Conclusion We report the first case of thoracic metastasis of recurrent Brenner tumor without local recurrence.
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Affiliation(s)
- Tomoaki Fujita
- Department of Neurosurgery, Kyoto Okamoto Memorial Hospital, Sayamanishinoguchi 100, Kumiyama-cho, Kuse-gun, Kyoto 613-0034 Japan,Corresponding author.
| | - Aya Takeya
- Department of Gynecology, Kyoto Okamoto Memorial Hospital, Sayamanishinoguchi 100, Kumiyama-cho, Kuse-gun, Kyoto 613-0034 Japan
| | - Haruka Miyata
- Department of Neurosurgery, Kyoto Okamoto Memorial Hospital, Sayamanishinoguchi 100, Kumiyama-cho, Kuse-gun, Kyoto 613-0034 Japan
| | - Futa Ninomiya
- Department of Neurosurgery, Kyoto Okamoto Memorial Hospital, Sayamanishinoguchi 100, Kumiyama-cho, Kuse-gun, Kyoto 613-0034 Japan
| | - Yutaka Nonoyama
- Department of Neurosurgery, Kyoto Okamoto Memorial Hospital, Sayamanishinoguchi 100, Kumiyama-cho, Kuse-gun, Kyoto 613-0034 Japan
| | - Takuya Nakazawa
- Department of Neurosurgery, Kyoto Okamoto Memorial Hospital, Sayamanishinoguchi 100, Kumiyama-cho, Kuse-gun, Kyoto 613-0034 Japan
| | - Yukiko Furuya
- Department of Gynecology, Kyoto Okamoto Memorial Hospital, Sayamanishinoguchi 100, Kumiyama-cho, Kuse-gun, Kyoto 613-0034 Japan
| | - Yasuyuki Enoki
- Department of Pathology, Kyoto Okamoto Memorial Hospital, Sayamanishinoguchi 100, Kumiyama-cho, Kuse-gun, Kyoto 613-0034 Japan
| | - Takashi Fujii
- Department of Radiotherapy, Kyoto Okamoto Memorial Hospital, Sayamanishinoguchi 100, Kumiyama-cho, Kuse-gun, Kyoto 613-0034 Japan
| | - Shigeharu Fukao
- Department of Neurosurgery, Kyoto Okamoto Memorial Hospital, Sayamanishinoguchi 100, Kumiyama-cho, Kuse-gun, Kyoto 613-0034 Japan
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Martens T, Schaballie H, Willekens J, Schelstraete P, Willems J, Muthialu N, Desender L. Anterior and posterior tracheopexy for severe tracheomalacia. JTCVS Tech 2023; 17:159-63. [PMID: 36820339 DOI: 10.1016/j.xjtc.2022.11.011] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Revised: 10/17/2022] [Accepted: 11/02/2022] [Indexed: 12/15/2022] Open
Abstract
Objectives Congenital tracheomalacia can be the cause of respiratory failure in young children. Although the indication for surgical treatment has already been discussed vigorously, no clear guidelines about the modality are available. Methods Through a sternotomy approach, a combination of posterior pexy and anterior tracheopexy using a tailored ringed polytetrafluoroethylene prosthesis is performed. Patient demographic characteristics, as well as operative details and postoperative outcomes, are included in the analysis. Results Between 2018 and 2022, 9 children underwent the operation under review. All patients showed severe clinical symptoms of tracheomalacia, which was confirmed on bronchoscopy. The median age was 9 months. There was no operative mortality. Eight patients could be weaned from the ventilator. One patient died because of interstitial lung disease with bronchomalacia and concomitant severe cardiac disease. The longest follow-up now is 4 years, and shows overall excellent clinical results, without any reintervention. Conclusions Surgical treatment of tracheomalacia through a combination of posterior and anterior pexy is feasible, with acceptable short- and midterm results.
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Affiliation(s)
| | - Masato Kadoya
- Address correspondence to Dr Masato Kadoya, Department of Internal Medicine, Japan Self-Defense Forces Central Hospital, 1-2-24 Ikejiri, Setagayaku, Tokyo, Japan.
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