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Postherpetic Neuralgia After Herpes Zoster Ophthalmicus. RHODE ISLAND MEDICAL JOURNAL (2013) 2024; 107:32-36. [PMID: 38166075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/04/2024]
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Pediatric Central Retinal Vein Occlusion Secondary to Concurrent Mechanisms of Optic Neuritis and Antiphospholipid Syndrome. JOURNAL OF VITREORETINAL DISEASES 2023; 7:245-248. [PMID: 37188213 PMCID: PMC10170615 DOI: 10.1177/24741264231153614] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/17/2023]
Abstract
Purpose: To report a pediatric case of optic neuritis with subsequent development of central retinal vein occlusion (CRVO). Methods: A case and its findings were analyzed. Results: A 16-year-old boy presented with painful vision loss in the left eye, an afferent pupillary defect, and optic disc edema. Magnetic resonance imaging showed optic nerve enhancement and contrast-enhancing cerebral white-matter lesions, consistent with optic neuritis and demyelinating disease. He received intravenous methylprednisolone followed by a prednisone taper. At the 3-week follow-up, the visual acuity (VA) in the left eye had worsened and fundoscopic examination showed a new CRVO. A hypercoagulable workup showed antiphospholipid syndrome, which was treated with warfarin. He received intravitreal antivascular endothelial growth factor treatment with subsequent improvement in VA and resolution of the macular edema. Conclusions: This case describes an unusual mechanism for CRVO via a combination of optic disc edema from optic neuritis and hypercoagulability from antiphospholipid syndrome. It is important to recognize this complication of optic disc edema and the necessary workup for a pediatric CRVO.
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Osteoporosis, Fractures, and Blindness Due to a Missense Mutation in the LRP5 Receptor. Orthop Res Rev 2023; 15:39-45. [PMID: 36987449 PMCID: PMC10040166 DOI: 10.2147/orr.s400111] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2022] [Accepted: 03/16/2023] [Indexed: 03/30/2023] Open
Abstract
Familial exudative vitreoretinopathy (FEVR) is a genetic disorder whose presentation can include osteoporosis, multiple fractures, and incomplete retinal angiogenesis leading to retinal detachment and blindness if left untreated. Discussed herein are the cases of two pediatric siblings who presented to the orthopedic service with multiple fractures and, through interdisciplinary management, were diagnosed with FEVR and treated appropriately before permanent visual impairment. The skeletal manifestations of FEVR, which have not been explored in depth in prior literature, are described. One sibling presented to orthopedic services for evaluation of a closed distal radius fracture sustained while playing sports. A comprehensive history revealed he had suffered at least four appendicular fractures in his lifetime, and dual-energy x-ray absorptiometry (DEXA) scan revealed his bone density to be in the first percentile for his age. Concurrent evaluation of his younger sibling revealed a similar history of multiple fractures and low bone density. Referral to genetic services and ensuing whole-exome sequencing revealed a likely pathogenic variant in both siblings' LRP5 gene, the only known causative mutation for FEVR that leads to skeletal manifestations. While FEVR is well known in genetic and ophthalmologic settings, greater awareness of FEVR and other genetic disorders that predispose to fractures in pediatric populations is warranted in orthopedic settings. This will lead to reduced sequelae in pediatric patients with genetic disorders and improved interdisciplinary expertise. The story of these siblings illustrates that a high index of suspicion for genetic diseases is essential when treating children with osteoporosis and growth delays.
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Central Retinal Vein Occlusion Secondary to Necrotizing Pancreatitis. RHODE ISLAND MEDICAL JOURNAL (2013) 2022; 105:50-51. [PMID: 36173910] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
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Author response to letter to editor. Re: Quantification of epi- and pericardial adipose tissue deposits between males and females during cardiac CT may potentially help categorize coronary artery disease risk with thoracic circumference. Radiography (Lond) 2021; 27:989. [PMID: 34074599 DOI: 10.1016/j.radi.2021.05.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2021] [Accepted: 05/06/2021] [Indexed: 10/21/2022]
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To repeat or not to repeat: Radiologists demonstrated more decisiveness than their fellow radiographers in reducing the repeat rate during mobile chest radiography. Radiography (Lond) 2020; 27:304-309. [PMID: 33023812 DOI: 10.1016/j.radi.2020.09.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2020] [Revised: 07/27/2020] [Accepted: 09/01/2020] [Indexed: 11/16/2022]
Abstract
INTRODUCTION Radiologists and radiographers play a complementary role in providing an optimal image quality with decrease radiation dose and proper diagnosis during chest radiographs. We aim Investigate years of experience among radiologists and radiographers on perception of image quality and its impact on repeat rate when evaluating portable pediatric chest radiographs. METHODS IRB approved retrospective study consisted of randomly selected images (n = 131) of pediatric portable chest radiographs. Images were blindly assessed by four radiologists and four radiographers. Readers were asked to assess qualitative and quantitative image quality by rating: image quality, decision to repeat and image technique. All data was compared employing Pearson's Correlation, Visual grading characteristic (VGC) and Cohens' kappa analyses. RESULTS Image quality: Radiologists (88.4%) rated images as excellent significantly more than radiographers (11.6%), and radiographers (90.1%) as poor significantly more than radiologists (9.9%) (p < 0.05). Repeat: Radiologists (57%) decided not to repeat images significantly more than radiographers (43%) (p < 0.05). Image technique: Radiologists rated images as acceptable (65%) and excellent (97.7%) significantly more than radiographers (35% and 2.3% respectively) (p < 0.05), whereas radiographers (84%) assessed image technique as poor significantly more than radiologists (16%) (p < 0.05). VGC: radiographers had slightly better qualitative evaluation of image quality than radiologists. An association between image quality (p < 0.002) and repeat decision (p < 0.044) with years of experience was established when comparing years of experience with image assessment rubric, while no association was noted with image technique (p < 0.9). CONCLUSION Radiologists demonstrated more decisiveness than their fellow radiographers in reducing the repeat rate of portable pediatric chest radiographs. Interestingly, years of experience only seem to affect image technique and image quality assessment among radiologists. IMPLICATIONS FOR PRACTICE Continuous education of radiographers and close collaboration with radiologists is crucial to achieve optimal image quality and low radiation doses.
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Staying abreast of imaging - Current status of breast cancer detection in high density breast. Radiography (Lond) 2020; 27:229-235. [PMID: 32611494 DOI: 10.1016/j.radi.2020.06.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2020] [Revised: 05/26/2020] [Accepted: 06/08/2020] [Indexed: 11/18/2022]
Abstract
OBJECTIVES The aim of this paper is to illustrate the current status of imaging in high breast density as we enter a new decade of advancing medicine and technology to diagnose breast lesions. KEY FINDINGS Early detection of breast cancer has become the chief focus of research from governments to individuals. However, with varying breast densities across the globe, the explosion of breast density information related to imaging, phenotypes, diet, computer aided diagnosis and artificial intelligence has witnessed a dramatic shift in new screening recommendations in mammography, physical examination, screening younger women and women with comorbid conditions, screening women at high risk, and new screening technologies. Breast density is well known to be a risk factor in patients with suspected/known breast neoplasia. Extensive research in the field of qualitative and quantitative analysis on different tissue characteristics of the breast has rapidly become the chief focus of breast imaging. A summary of the available guidelines and modalities of breast imaging, as well as new emerging techniques under study that can potentially provide an augmentation or even a replacement of those currently available. CONCLUSION Despite all the advances in technology and all the research directed towards breast cancer, detection of breast cancer in dense breasts remains a dilemma. IMPLICATIONS FOR PRACTICE It is of utmost importance to develop highly sensitive screening modalities for early detection of breast cancer.
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State of the art of coronary computed tomography angiography. Radiography (Lond) 2020; 26:174-182. [PMID: 32052781 DOI: 10.1016/j.radi.2019.10.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2019] [Revised: 09/21/2019] [Accepted: 10/02/2019] [Indexed: 01/07/2023]
Abstract
OBJECTIVES The aim of this paper is to evaluate contrast media (CM) bolus geometry and opacification patterns in the coronary arteries with particular focus on patient, scanner and safety considerations during coronary computed tomography angiography (CCTA). KEY FINDINGS The rapid evolution of computed tomography (CT) technology has seen this imaging modality challenge conventional coronary angiography in the evaluation of coronary artery disease. Increases in spatial and temporal resolutions have enabled CCTA to become the modality of choice when evaluating the coronary vascular tree as an alternative in the diagnostic algorithm for acute chest pain. However, these new technologic improvements in scanner technology have imposed new challenges for the optimisation of CM delivery and image acquisition strategies. CONCLUSION Understanding basic CM-imaging principles is essential for designing optimal injection protocols according to each specific clinical scenario, independently of scanner technology. IMPLICATIONS FOR PRACTICE With rapid advances in CT scanner technology including faster scan acquisitions, the risk of poor opacification of coronary vasculature increases significantly. Therefore, awareness of CM delivery protocols is paramount to consistently provide optimal image quality at a low radiation dose.
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Crohn's disease: A retrospective analysis between computed tomography enterography, colonoscopy, and histopathology. Radiography (Lond) 2019; 25:349-358. [PMID: 31582244 DOI: 10.1016/j.radi.2019.04.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2018] [Revised: 04/10/2019] [Accepted: 04/18/2019] [Indexed: 02/07/2023]
Abstract
INTRODUCTION To investigate the spectrum of computed tomography enterography (CTE) findings of active Crohn's disease (CD) in comparison to endoscopic, histopathologic and inflammatory markers. METHODS Hospital records of 197 patients with known or suspected CD who underwent CTE over a period of 5 years were reviewed. Eighty-nine patients fulfilled the inclusion criteria. Three-point severity scores for endoscopy, pathology, and haematologic inflammatory markers were recorded. The findings on CTE were identified by three readers and correlated with endoscopic, pathologic, and haematologic severity scores. Statistical analysis was carried out employing a Pearson Chi square test and Fisher exact test. Receiver operating characteristic (ROC), visual grading characteristic (VGC) and Cohens' kappa analyses were performed. RESULTS The CTE findings which were significantly correlated with the severity of active disease on endoscopy include bowel wall thickening, mucosal hyperenhancement, bilaminar stratified wall enhancement, transmural wall enhancement, and mesenteric fluid adjacent to diseased bowel (p < 0.05). Only bowel wall thickening and bilaminar stratified wall enhancement correlated with the pathological severity of active CD. ROC and VGC analysis demonstrated significantly higher areas under the curve (p < 0.0001) together with excellent inter-reader agreement (k = 0.86). CONCLUSION CTE is a reliable tool for evaluating the severity of active disease and helps in the clinical decision pathway.
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Sarcopenic obesity derived from PET/CT predicts mortality in lymphoma patients undergoing hematopoietic stem cell transplantation. Curr Res Transl Med 2018; 67:93-99. [PMID: 30583985 DOI: 10.1016/j.retram.2018.12.001] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2018] [Revised: 11/07/2018] [Accepted: 12/15/2018] [Indexed: 12/28/2022]
Abstract
BACKGROUND Sarcopenic Obesity (SO) is associated with worse survival among chemotherapy recipients. Research on SO is scarce among lymphoma patients receiving Hematopoietic Stem Cell Transplantation (HSCT). AIM assess prevalence of SO pre-HSCT (T0) and 3 months post-HSCT (T1) in lymphoma patients and determine the power of SO at T0 and T1 in predicting survival. METHODS Consecutive patients (age ≥16 years) having B and T cell lymphoma who underwent SCT and who had PET/CT scan pre-SCT and 3 months post SCT were included in the study. A cross sectional image was analyzed at the level of the 3rd Lumber Vertebrae to assess body composition parameters. RESULTS 93 patients [mean age: 38 (range: 17-70 years), 52 (55.9%) males, 45 (48%) Hodgkin and 48 (52%) Non-Hodgkin lymphoma, 81 (87%) autologous and 12 (13%) allogeneic SCT)] met the inclusion criteria. From T0 to T1, Sarcopenia rates increased (27% at T0 to 38% at T1, p = 0.013), Visceral adiposity decreased (46% at T0 to 30% at T1, p = 0.03) and SO decreased (42% at T0 to 20% at T1, p < 0.01). Length of stay, overall survival and progression free survival were significantly better in patients without sarcopenic obesity at T1. Cox-regression revealed SO at T1 was a risk factor for mortality [Adjusted Hazards Ratio = 8.2 (95% Confidence Interval: 1.9-36.2)]. CONCLUSION Sarcopenic obesity, prevalent in 42% of patients pre-HSCT, decreased 3 months post HSCT as lymphoma patients lost skeletal muscle and visceral adipose tissues. SO at T1 was the most impactful risk factor for mortality.
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Gadolinium and Multiple Sclerosis: Vessels, Barriers of the Brain, and Glymphatics. AJNR Am J Neuroradiol 2018; 39:2168-2176. [PMID: 30385472 DOI: 10.3174/ajnr.a5773] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2017] [Accepted: 06/05/2018] [Indexed: 01/10/2023]
Abstract
The pathogenesis of multiple sclerosis is characterized by a cascade of pathobiologic events, ranging from focal lymphocytic infiltration and microglia activation to demyelination and axonal degeneration. MS has several of the hallmarks of an inflammatory autoimmune disorder, including breakdown of the BBB. Gadolinium-enhanced MR imaging is currently the reference standard to detect active inflammatory lesions in MS. Knowledge of the patterns and mechanisms of contrast enhancement is vital to limit the radiologic differential diagnosis in the staging and evaluation of MS lesion activity. The aim of this review was the following: 1) to outline the pathophysiology of the effect of lymphocyte-driven inflammation in MS, 2) to describe the effects of gadolinium on the BBB and glymphatic system, and 3) to describe gadolinium enhancement patterns and artifacts that can mimic lesions in MS.
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Increased image quality and reduced radiation dose and contrast media volume: a holistic approach to intracranial CTA. Clin Radiol 2017; 72:797.e11-797.e16. [PMID: 28477959 DOI: 10.1016/j.crad.2017.03.025] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2016] [Revised: 02/17/2017] [Accepted: 03/29/2017] [Indexed: 11/28/2022]
Abstract
AIM To investigate the dose-length product (DLP) during intracranial computed tomography angiography (CTA) using a patient-specific contrast formula. MATERIALS AND METHODS Intracranial CTA was performed on 120 patients using 64-channel CT. Patients were subjected in equal numbers to one of two acquisitions/contrast medium protocols. Protocol A, consisted of 80 ml contrast medium and protocol B, involved a novel contrast medium formula. In each protocol, contrast medium and saline were injected at a flow rate of 4.5 ml/s. The DLP and contrast volume (CV) were measured between each protocol and the data obtained were compared using two-tailed independent t-test. RESULTS Mean arterial vessel attenuation was up to 56% (p<0.01) higher using protocol B compared with A. In the venous system, the mean vessel attenuation was significantly lower in protocol B than A with a maximum reduction of 93% (p<0.001). The mean CV was significantly lower in protocol B (53±10 ml) compared to A (80±1 ml, p<0.001). The scan time was equal in each protocol (B, 4.22±1.2 seconds; A, 4.01±1.3 seconds). A significant reduction in mean DLP was demonstrated in protocol B (3.99±0.22 mSv) compared to A (4.74±0.22 mSv; p=0.02). CONCLUSION A significant reduction in CV and DLP during intracranial CTA can be achieved when employing a patient-specific contrast medium formula.
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A case of a 42-year-old patient with anomalous origin of the left main coronary artery from the pulmonary artery who delivered three times with no complications: presentation, diagnosis, and review. CLIN EXP OBSTET GYN 2016. [DOI: 10.12891/ceog3032.2016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
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The diagnostic yield of ultrasound of the head in healthy infants presenting with the clinical diagnosis of benign macrocrania. Clin Radiol 2016; 72:94.e7-94.e11. [PMID: 27756452 DOI: 10.1016/j.crad.2016.08.012] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2016] [Revised: 08/12/2016] [Accepted: 08/31/2016] [Indexed: 10/20/2022]
Abstract
AIM To investigate the frequency of sonographic findings that required neurosurgical consultation for all referred outpatients suspected to have benign macrocrania (BMC). MATERIALS AND METHODS A retrospective review was performed from September 2011 until June 2015 for all outpatients referred to the ultrasound (US) department for BMC. Electronic medical records, US images, and reports were reviewed in conjunction with follow-up imaging. Each review consisted of gender, specialty of referring physician, first head circumference, head circumference at or closest to the time of the head US, the last head circumference, and any neurological issue prior to the US, at the time of US, or following the US, and clinical outcomes. Statistical analysis employed the Kruskal-Wallis rank sum test and Fischer's exact test (chi square test of independence) that compared normal/BMC patients from the patients requiring a neurosurgical consultation. RESULTS One hundred and thirty (40.9%) had a normal head US, 181 patients (56.9%) had sonographic findings of BMC, and seven (2.2%) patients had an abnormal head US that required a neurosurgical consultation. Of the 181 patients with BMC, 23 underwent follow-up imaging with 22 patients having unchanged BMC or a normal head US and one patient developing mild ventriculomegaly that was stable on follow-up imaging. Three of the seven patients (1%) aged 1.8, 2.3, and 13.1 months with abnormal head US requiring neurosurgical consultation, had mild ventriculomegaly that was stable on follow-up imaging. Four of the seven patients (1.2%) that required neurosurgical consultation needed a neurosurgical procedure. Between the two US subgroups (normal and BMC), no statistical significance was noted regarding age of patient at US, head circumference at clinical and radiological presentation (p>0.05) except for the first head circumference clinically documented which demonstrated statistical significance (p<0.03). CONCLUSION Short interval surveillance including head circumference and assessment for the development of bulging anterior fontanelle and neurological abnormalities may be more cost effective than US in the initial evaluation of patients clinically suspected to have BMC.
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Abstract
PURPOSE Subretinal drusenoid deposits (SDD) are the main structural lesion of reticular macular disease (RMD), a phenotype of age-related macular degeneration (AMD). We aim to demonstrate spatiotemporal relationships between SDD and choroidal thickness (CTh) alterations in RMD+ and RMD- eyes. METHODS Thirty-three eyes (26 subjects) with early AMD/no SDD (RMD-) and 18 eyes (16 subjects) with early AMD/SDD (RMD+) underwent enhanced depth imaging spectral domain optical coherence tomography (SD-OCT) for CTh measurements at 11 points per scan, in 5 horizontal B scans, creating a grid of 55 points/eye. The 55 points were treated as a cluster, controlling within-subject correlation. Marginal generalized estimating equation modeling was used to estimate the association between CTh and RMD status. All eyes were divided by their median age (≤82 and >82 years) for stratified analyses. RESULTS CTh was not significantly reduced in RMD+ eyes compared with RMD- eyes (mean difference [MD] -16.84 μm, P = 0.24). Among younger subjects, mean CTh was significantly reduced in RMD+ versus RMD- eyes (MD -53.72 μm, P = 0.01). Conversely, among older subjects, there was no significant difference in CTh between RMD+ and RMD-. CONCLUSIONS In RMD, the association of SDD and CTh alterations varies with age but not by macular region. Among younger subjects (<82 years old), CTh was significantly thinner in RMD+ versus RMD- eyes.
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Geographic Atrophy and Choroidal Neovascularization in the Same Eye: A Review. Ophthalmic Res 2016; 55:185-93. [PMID: 26871899 PMCID: PMC4845740 DOI: 10.1159/000443209] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2015] [Accepted: 12/07/2015] [Indexed: 12/28/2022]
Abstract
Geographic atrophy (GA) and choroidal neovascularization (CNV), the two late forms of age-related macular degeneration, are generally considered two distinct entities. However, GA and CNV can occur simultaneously in the same eye, with GA usually occurring first. The prevalence of this combined entity is higher in histological studies than in clinical studies. No distinct systemic or genetic risk characteristics are associated with the combined GA/CNV entity, although on clinical examination and retinal imaging it can feature drusen or subretinal drusenoid deposits. GA and CNV may exist within the spectrum of a single disease, or they may be two very different diseases. Therapy with antivascular endothelial growth factor (anti-VEGF) is often successful for CNV, but some evidence suggests increased rates of GA development in eyes treated with anti-VEGF. In this article, we review the current literature regarding the epidemiology, clinical presentation, and treatment options for patients with the combined GA/CNV entity.
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A case of a 42-year-old patient with anomalous origin of the left main coronary artery from the pulmonary artery who delivered three times with no complications: presentation, diagnosis, and review. CLIN EXP OBSTET GYN 2016; 43:889-892. [PMID: 29944246] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
An anomalous origin of the left coronary artery (LCA) from the pulmonary artery or Bland-White-Garland (BWG) syndrome is a rare congenital cardiac anomaly, which is unusual to survive to adulthood if left uncorrected. The authors report an unusual case of a multiparity patient who delivered several times without any complications presenting at the age of 42 years with recurrent dyspnea on exertion in which echocardiographic findings of diastolic flow near the origin of the pulmonary valve were suggestive of anomalous origin of the LCA. A CT angiography confirmed that the left main coronary artery arises from the undersurface of the pulmonary flow close :o its origin and gives rise to a left anterior descending (LAD) and left circumflex arteries.
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Predictors of pneumothorax after CT-guided transthoracic needle lung biopsy: the role of quantitative CT. Clin Radiol 2015; 70:1382-7. [DOI: 10.1016/j.crad.2015.08.003] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2015] [Revised: 07/28/2015] [Accepted: 08/04/2015] [Indexed: 11/30/2022]
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9.1 cm abdominal aortic aneurysm in a 69-year-old male patient. World J Cardiol 2015; 7:157-160. [PMID: 25810816 PMCID: PMC4365305 DOI: 10.4330/wjc.v7.i3.157] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2014] [Revised: 12/07/2014] [Accepted: 01/20/2015] [Indexed: 02/06/2023] Open
Abstract
We are presenting a case of one of the largest un-ruptured abdominal aortic aneurysm ever reported. Presented here is a rare case of a 69-year-old active smoker male with history of hypertension and incidental diagnosis of abdominal aortic aneurysm of 6.2 cm in 2003, who refused surgical intervention at the time of diagnosis with continued smoking habit and was managed medically. Patient was subsequently admitted in 2012 to the hospital due to unresponsiveness secondary to hypoglycemia along with diagnosis of massive symptomatic pulmonary embolism and non-ST elevation myocardial infarction. With the further inpatient workup along with known history of abdominal aortic aneurysm, subsequent computed tomography scan of abdomen pelvis revealed increased in size of infrarenal abdominal aortic aneurysm to 9.1 cm of without any signs of rupture. Patient was unable to undergo any surgical intervention this time because of his medical instability and was eventually passed away under hospice care.
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Reticular macular lesions: a review of the phenotypic hallmarks and their clinical significance. Clin Exp Ophthalmol 2014; 42:865-74. [PMID: 24803342 DOI: 10.1111/ceo.12353] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2013] [Accepted: 04/08/2014] [Indexed: 12/18/2022]
Abstract
Reticular macular lesions, also known as 'reticular macular disease', 'reticular drusen', 'reticular pseudodrusen', or 'subretinal drusenoid deposits', are a pattern of lesions commonly found in age-related macular degeneration and best visualized using at least two imaging techniques in combination. Reticular lesions have four stages of progression observable on spectral domain optical coherence tomography, but they do not show the usual signs of regression of soft drusen (calcification and pigment changes). Furthermore, reticular lesions correlate histologically with subretinal drusenoid deposits localized between the retinal pigment epithelium and the inner segment ellipsoid band. Reticular lesions are most commonly seen in older age groups of female patients with age-related macular degeneration and are usually bilateral. They are not clearly associated with known age-related macular degeneration genes and are highly associated with late-stage age-related macular degeneration and an increased mortality rate. They are also associated with alterations in the neural retina and choroid.
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Risk characteristics of the combined geographic atrophy and choroidal neovascularisation phenotype in age-related macular degeneration. Br J Ophthalmol 2014; 98:1729-32. [PMID: 25091949 DOI: 10.1136/bjophthalmol-2014-305005] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
AIM To investigate the risk characteristics of the combined geographic atrophy (GA) and choroidal neovascularisation (CNV) phenotype of age-related macular degeneration (AMD) compared to GA or CNV. METHODS Patients with advanced AMD were identified and divided into three groups using multimodal imaging: patients with GA in at least one eye, patients with CNV in at least one eye, and patients with simultaneous GA and CNV in at least one eye. Epidemiologic and clinical factors were gathered from patient questionnaires. Genotypes for age-related maculopathy susceptibility 2 (ARMS2) and complement factor H (CFH) were determined. RESULTS 42 patients with GA or CNV, and 16 patients with combined GA/CNV were identified. Patients with the combined phenotype were older (86.4 vs 81.8 years, p=0.049), and had a higher prevalence of advanced AMD in the fellow eye (81.3% vs 31.0%, p<0.001). CFH and ARMS2 risk alleles were not associated with the combined phenotype. CONCLUSIONS The combined GA/CNV phenotype has similar epidemiologic, clinical, and genetic features as GA and CNV, but occurs at an older age and is more associated with advanced AMD in the fellow eye, suggesting that all these phenotypes are part of the same spectrum of disease and that the combined phenotype represents an even more advanced form of AMD than either GA or CNV.
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Abstract
Leiomyosarcoma of the inferior vena cava is a rare primary tumour. We present a case report of a 67-year-old man with a long history of abdominal pain and gastroesophageal reflux, who was found to have a large retroperitoneal mass confirmed to be a leiomyosarcoma. The clinical and imaging features are outlined, and in addition the treatment and prognosis.
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[Flexibility of mental representations of spatial information as a function of perspective during learning]. ZEITSCHRIFT FUR EXPERIMENTELLE PSYCHOLOGIE : ORGAN DER DEUTSCHEN GESELLSCHAFT FUR PSYCHOLOGIE 2000; 47:180-94. [PMID: 10949904] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/17/2023]
Abstract
View-based theories of the mental representation of spatial information claim that distinct views experienced during learning are represented separately in memory. Networks of such views are considered to be the basis for spatial navigation. Two experiments (N = 56) investigated the role of observer perspective on the resulting mental representation when learning a spatial configuration on the computer. Learning in route perspective, which induced the impression of passive navigation through the configuration, was compared with a survey perspective, which consisted of an overview of the whole configuration from one point of view. In accordance with view-based theories, previously seen views could be identified faster and with less error than new views for both perspectives during learning. Recoding the information into the alternative perspective was also possible. If participants were asked to integrate distinct route views into a survey view during learning, the flexibility of the resulting mental representation was greatly increased. This indicates that conscious processes such as imagery play an important role in the integration of spatial knowledge.
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[A rare manifestation of hypothyroidism: intestinal obstruction. Report of 2 cases and review of the literature]. LE JOURNAL MEDICAL LIBANAIS. THE LEBANESE MEDICAL JOURNAL 1999; 47:364-6. [PMID: 10758712] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/14/2023]
Abstract
Gastrointestinal manifestations of hypothyroidism are unfrequent. They consist particularly in hypomotility, intestinal atony, and pseudoobstruction. A high index of suspicion must exist, especially in elder subjects, in order to avoid unnecessary and even harmful investigation and intervention. We are reporting two cases of intestinal occlusion due to hypothyroidism with review of the literature.
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26
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[Diabetes and pregnancy. Part II: obstetrical aspects]. LE JOURNAL MEDICAL LIBANAIS. THE LEBANESE MEDICAL JOURNAL 1998; 46:280-3. [PMID: 10349262] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/12/2023]
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27
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[Diabetes and pregnancy. I. Metabolic aspects]. LE JOURNAL MEDICAL LIBANAIS. THE LEBANESE MEDICAL JOURNAL 1998; 46:199-205. [PMID: 9880986] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/09/2023]
MESH Headings
- Adult
- Birth Weight
- Congenital Abnormalities/etiology
- Diabetes Mellitus, Type 1/complications
- Diabetes Mellitus, Type 1/metabolism
- Diabetes Mellitus, Type 2/complications
- Diabetes Mellitus, Type 2/metabolism
- Diabetes, Gestational/diagnosis
- Diabetes, Gestational/metabolism
- Diabetic Nephropathies/diagnosis
- Diabetic Neuropathies/diagnosis
- Diabetic Retinopathy/diagnosis
- Female
- Humans
- Infant, Newborn
- Infant, Newborn, Diseases/diagnosis
- Infant, Newborn, Diseases/etiology
- Pregnancy
- Pregnancy in Diabetics/diagnosis
- Pregnancy in Diabetics/metabolism
- Risk Factors
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28
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Should cholecystectomy be done en passant for asymptomatic cholelithiasis? Can J Surg 1987; 30:350-3. [PMID: 3664389] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
The management of asymptomatic gallstones discovered during abdominal surgery is controversial. Should cholecystectomy be performed en passant? The authors report a 4-year survey of 109 patients with asymptomatic cholelithiasis who underwent surgery for other abdominal conditions: colorectal (31), gastric (24), vascular (20), gynecologic (21) and miscellaneous (13). Cholelithiasis was established preoperatively by ultrasonography in 52 of 55 examinations (95%). In the other 54, the gallstones were discovered at operation. Cholecystectomy was performed in 78 patients and in 31 the gallbladder was left in place. In the former group, 11 (14%) had complications, 2 being attributable to the cholecystectomy. Intraoperative cholangiograms were obtained in 43 and led to common-bile-duct explorations in 8. Common-bile-duct stones were found in seven. In the non-cholecystectomized group, three died postoperatively and three were lost to follow-up. Twelve of the remaining 25 are still asymptomatic and 13 have had symptoms: 7 underwent cholecystectomy (4 for acute cholecystitis) between 2 weeks and 11 months after the initial laparotomy. Because of the low morbidity and the relatively high number of cholecystectomies that were subsequently necessary, the authors recommend cholecystectomy en passant unless there is a specific contraindication. They also recommend ultrasonography before major gastrointestinal or vascular surgery in order to plan for cholecystectomy.
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