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Bongers MER, Ogink PT, Chu KF, Patel A, Rosenthal B, Shin JH, Lee SG, Hornicek FJ, Schwab JH. The use of autologous free vascularized fibula grafts in reconstruction of the mobile spine following tumor resection: surgical technique and outcomes. J Neurosurg Spine 2020:1-10. [PMID: 33157532 DOI: 10.3171/2020.6.spine20521] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2020] [Accepted: 06/29/2020] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Reconstruction of the mobile spine following total en bloc spondylectomy (TES) of one or multiple vertebral bodies in patients with malignant spinal tumors is a challenging procedure with high failure rates. A common reason for reconstructive failure is nonunion, which becomes more problematic when using local radiation therapy. Radiotherapy is an integral part of the management of primary malignant osseous tumors in the spine. Vascularized grafts may help prevent nonunion in the radiotherapy setting. The authors have utilized free vascularized fibular grafts (FVFGs) for reconstruction of the spine following TES. The purpose of this article is to describe the surgical technique for vascularized reconstruction of defects after TES. Additionally, the outcomes of consecutive cases treated with this technique are reported. METHODS Thirty-nine patients were treated at the authors' tertiary care institution for malignant tumors in the mobile spine using FVFG following TES between 2010 and 2018. Postoperative union, reoperations, complications, neurological outcome, and survival were reported. The median follow-up duration was 50 months (range 14-109 months). RESULTS The cohort consisted of 26 males (67%), and the median age was 58 years. Chordoma was the most prevalent tumor (67%), and the lumbar spine was most affected (46%). Complete union was seen in 26 patients (76%), the overall complication rate was 54%, and implant failure was the most common complication, with 13 patients (33%) affected. In 18 patients (46%), one or more reoperations were needed, and the fixation was surgically revised 15 times (42% of reoperations) in 10 patients (26%). A reconstruction below the L1 vertebra had a higher proportion of implant failure (67%; 8 of 12 patients) compared with higher resections (21%; 5 of 24 patients) (p = 0.011). Graft length, number of resected vertebrae, and docking the FVFG on the endplate or cancellous bone was not associated with union or implant failure on univariate analysis. CONCLUSIONS The FVFG is an effective reconstruction technique, particularly in the cervicothoracic spine. However, high implant failure rates in the lumbar spine have been seen, which occurred even in cases in which the graft completely healed. Methods to increase the weight-bearing capacity of the graft in the lumbar spine should be considered in these reconstructions. Overall, the rates of failure and revision surgery for FVFG compare with previous reports on reconstruction after TES.
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Affiliation(s)
| | - Paul T Ogink
- Departments of1Orthopedic Surgery, Orthopedic Oncology Service
| | | | - Anuj Patel
- Departments of1Orthopedic Surgery, Orthopedic Oncology Service
| | - Brett Rosenthal
- Departments of1Orthopedic Surgery, Orthopedic Oncology Service
| | | | - Sang-Gil Lee
- 4Orthopedic Surgery, Hand and Upper Extremity Service, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts; and
| | - Francis J Hornicek
- 5Department of Orthopedic Surgery, Orthopedic Oncology Service, University of California, Los Angeles Medical Center, Los Angeles, California
| | - Joseph H Schwab
- Departments of1Orthopedic Surgery, Orthopedic Oncology Service
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Dontchos BN, Edmonds CE, Mercaldo SF, Miles RC, Chu KF, Lehman CD. Patient-Assisted Compression in Screening Mammography: Patient Experience and Image Quality. J Breast Imaging 2019; 1:192-198. [PMID: 38424767 DOI: 10.1093/jbi/wbz024] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2019] [Indexed: 03/02/2024]
Abstract
OBJECTIVE Screening mammography is critical to reduce breast cancer mortality, yet many women cite pain from compression as a reason they avoid this test. We evaluated patient experience and image quality in screening patients opting for a handheld patient-assisted compression (PAC) device. METHODS After institutional review board approval, women screened between February and July 2018 with a synthetic 2D/tomosynthesis mammography unit were offered use of a handheld PAC device. Patient experience through survey, image quality, compression thickness, compression force, and average glandular dose were evaluated and compared between women opting for PAC and women opting for technologist-controlled compression (TC). Multivariable ordinal logistic and linear regression models were estimated to control for age and breast density. In addition, for women opting for PAC, image quality obtained with their current PAC mammogram was compared with that obtained with their prior TC mammogram, by using Wilcoxon/Pearson tests. RESULTS Seventy-three percent of women preferred their mammogram experience with PAC compared with their prior mammogram without PAC. Women using PAC reported decreased anxiety compared with those using TC, after controlling for age and breast density (adjusted odds ratio [aOR] 0.22 [95% confidence interval (CI): 0.09-0.49]). There were no significant differences in image quality, compression thickness, or average glandular dose in exams for women using PAC compared with exams for women using TC. Women using PAC had significantly more compression force than women using TC had (P = 0.012). CONCLUSIONS Mammography with PAC improves patient experience and results in similar image quality compared with mammography with TC.
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Affiliation(s)
- Brian N Dontchos
- Massachusetts General Hospital, Department of Radiology, Boston, MA
| | | | - Sarah F Mercaldo
- Massachusetts General Hospital, Department of Radiology, Boston, MA
| | - Randy C Miles
- Massachusetts General Hospital, Department of Radiology, Boston, MA
| | - Katrina F Chu
- Massachusetts General Hospital, Department of Radiology, Boston, MA
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Chu KF, Moran CJ, Wu K, Kaplan JL, Savarino JR, Board T, Israel EJ, Winter HS, Gee MS. Performance of Surveillance MR Enterography (MRE) in Asymptomatic Children and Adolescents With Crohn's Disease. J Magn Reson Imaging 2019; 50:1955-1963. [DOI: 10.1002/jmri.26811] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2019] [Revised: 05/14/2019] [Accepted: 05/15/2019] [Indexed: 12/24/2022] Open
Affiliation(s)
- Katrina F. Chu
- Department of RadiologyMassachusetts General Hospital Boston Massachusetts USA
| | - Christopher J. Moran
- Department of Pediatric GastroenterologyMassachusetts General Hospital Boston Massachusetts USA
| | - Kaiming Wu
- Department of RadiologyMassachusetts General Hospital Boston Massachusetts USA
| | - Jess L. Kaplan
- Department of Pediatric GastroenterologyMassachusetts General Hospital Boston Massachusetts USA
| | - Jeffrey R. Savarino
- Department of Pediatric GastroenterologyMassachusetts General Hospital Boston Massachusetts USA
| | - Tamsin Board
- Department of Pediatric GastroenterologyMassachusetts General Hospital Boston Massachusetts USA
| | - Esther J. Israel
- Department of Pediatric GastroenterologyMassachusetts General Hospital Boston Massachusetts USA
| | - Harland S. Winter
- Department of Pediatric GastroenterologyMassachusetts General Hospital Boston Massachusetts USA
| | - Michael S. Gee
- Department of RadiologyMassachusetts General Hospital Boston Massachusetts USA
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Li MD, Chu KF, DePietro A, Wu V, Wehrenberg-Klee E, Zurkiya O, Liu RW, Ganguli S. Same-Day Yttrium-90 Radioembolization: Feasibility with Resin Microspheres. J Vasc Interv Radiol 2019; 30:314-319. [PMID: 30819470 DOI: 10.1016/j.jvir.2018.10.016] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2018] [Revised: 08/22/2018] [Accepted: 10/15/2018] [Indexed: 02/08/2023] Open
Abstract
PURPOSE To evaluate the feasibility of a same-day yttrium-90 (90Y) radioembolization protocol with resin microspheres (including pretreatment angiography, lung shunt fraction [LSF] determination, and radioembolization) for the treatment of hepatocellular carcinoma (HCC) and liver metastases. MATERIALS AND METHODS All same-day radioembolization procedures performed over 1 y (February 2017 to January 2018) were included in this single-institutional retrospective analysis, in which 34 procedures were performed in 26 patients (median age, 63 y; 13 women), 19 with liver metastases and 7 with HCC. Yttrium-90 treatment activities were calculated by body surface area method. Tumor imaging response was assessed by Response Evaluation Criteria In Solid Tumors (RECIST) 1.1 for liver metastases and modified RECIST for HCC. Clinical side effects and adverse events were graded per Common Terminology Criteria for Adverse Events version 4.0. RESULTS All planned cases were technically successful, and no cases were canceled for elevated LSF or vascular anatomic reasons. Pretreatment angiography modified the planned 90Y treatment activity in 1 case in which vascular anatomy required a lobar-dose split into 2 for segmental infusions. In 18% of cases, patients were briefly admitted after the procedure for observation or symptom management. Imaging evaluation of initial efficacy at 1 month demonstrated partial response in 25% and stable disease in 67% of patients with liver metastases and partial/complete response in 43% and stable disease in 14% of patients with HCC. Grade ≥ 3 adverse events occurred in 6% of cases, with no systemic therapy-limiting toxicities. The mean total procedure time was 4.2 hours. CONCLUSIONS A same-day 90Y radioembolization protocol with resin microspheres is feasible in select patients, which can expedite cancer therapy.
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Affiliation(s)
- Matthew D Li
- Division of Interventional Radiology, Department of Radiology, Massachusetts General Hospital and Harvard Medical School, 55 Fruit St., GRB 290 Boston, MA 02114
| | - Katrina F Chu
- Division of Interventional Radiology, Department of Radiology, Massachusetts General Hospital and Harvard Medical School, 55 Fruit St., GRB 290 Boston, MA 02114
| | - Allegra DePietro
- Division of Nuclear Medicine and Molecular Imaging, Department of Radiology, Massachusetts General Hospital and Harvard Medical School, 55 Fruit St., GRB 290 Boston, MA 02114
| | - Vincent Wu
- Division of Interventional Radiology, Department of Radiology, Massachusetts General Hospital and Harvard Medical School, 55 Fruit St., GRB 290 Boston, MA 02114
| | - Eric Wehrenberg-Klee
- Division of Interventional Radiology, Department of Radiology, Massachusetts General Hospital and Harvard Medical School, 55 Fruit St., GRB 290 Boston, MA 02114
| | - Omar Zurkiya
- Division of Interventional Radiology, Department of Radiology, Massachusetts General Hospital and Harvard Medical School, 55 Fruit St., GRB 290 Boston, MA 02114
| | - Raymond W Liu
- Division of Interventional Radiology, Department of Radiology, Massachusetts General Hospital and Harvard Medical School, 55 Fruit St., GRB 290 Boston, MA 02114
| | - Suvranu Ganguli
- Division of Interventional Radiology, Department of Radiology, Massachusetts General Hospital and Harvard Medical School, 55 Fruit St., GRB 290 Boston, MA 02114.
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Abstract
Minimally invasive thermal ablation of tumours has become common since the advent of modern imaging. From the ablation of small, unresectable tumours to experimental therapies, percutaneous radiofrequency ablation, microwave ablation, cryoablation and irreversible electroporation have an increasing role in the treatment of solid neoplasms. This Opinion article examines the mechanisms of tumour cell death that are induced by the most common thermoablative techniques and discusses the rapidly developing areas of research in the field, including combinatorial ablation and immunotherapy, synergy with conventional chemotherapy and radiation, and the development of a new ablation modality in irreversible electroporation.
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Affiliation(s)
- Katrina F Chu
- The Department of Diagnostic Imaging, The Warren Alpert Medical School of Brown University and Rhode Island Hospital, 593 Eddy Street, Providence, Rhode Island 02903, USA
| | - Damian E Dupuy
- The Department of Diagnostic Imaging, The Warren Alpert Medical School of Brown University and Rhode Island Hospital, 593 Eddy Street, Providence, Rhode Island 02903, USA
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Chu KF, Samara MS, Laver N, Wein RO. A rare presentation of a large extra-abdominal desmoid tumor of the posterior neck and back. Am J Otolaryngol 2013; 34:727-30. [PMID: 24035615 DOI: 10.1016/j.amjoto.2013.08.013] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2013] [Accepted: 08/03/2013] [Indexed: 12/01/2022]
Abstract
OBJECTIVE To describe a difficult case of a large extra-abdominal desmoid fibroma of the posterior neck and back; to discuss the pathologic findings and treatment options of this case and to review the current literature for a rare presentation of this disease. METHOD A case report and review of the current relevant English literature, carried out using PubMed Medline, are presented. RESULTS We present a challenging case in which a locally invasive desmoid of the posterior neck and back had grown to such an extent that complete surgical excision in one procedure was not possible. CONCLUSION Extra-abdominal desmoid fibromas are rare tumors with multiple treatment options. The literature supports incomplete surgical resection when necessary to reduce postoperative morbidity. Further options described for residual or recurrent disease include repeat surgical excision, radiation therapy, and possible chemotherapy. For particularly large tumors, close observation and a planned second stage procedure are an appropriate choice.
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Affiliation(s)
- Katrina F Chu
- The Warren Alpert Medical School of Brown University, Providence, RI, USA.
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Chu KF, Sullivan SR, Taylor HO. CASE REPORT Pan-Suture Synostosis After Posterior Vault Distraction. Eplasty 2013; 13:e52. [PMID: 24106565 PMCID: PMC3791821] [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] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
OBJECTIVE Posterior vault remodeling by distraction osteogenesis is a relatively new technique used for initial correction of turribrachycephaly in children with bicoronal craniosynostosis. We present a new potential complication from this procedure; a case of pan-suture synostosis subsequent to posterior vault distraction. METHODS We report an infant girl who presented with bicoronal synostosis in the setting of Saethre-Chotzen syndrome. She underwent posterior vault distraction and was distracted a total of 34 millimeters, with successful osteogenesis at the site. RESULTS One year postoperatively, the patient was found to have incidental, asymptomatic pan-suture synostosis on computed tomography. CONCLUSIONS To our knowledge, this is the first reported case of delayed craniosynostosis after posterior vault distraction in the literature. The possible pathogenesis and significance of this case are discussed with a review of the current literature.
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Affiliation(s)
| | - Stephen R. Sullivan
- aWarren Alpert Medical School of Brown University,bDepartment of Plastic Surgery, Rhode Island Hospital and Hasbro Children's Hospital, Providence, RI
| | - Helena O. Taylor
- aWarren Alpert Medical School of Brown University,bDepartment of Plastic Surgery, Rhode Island Hospital and Hasbro Children's Hospital, Providence, RI,Correspondence:
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Abstract
Automatic detection of several features characteristic of basal cell epitheliomas is described. The features selected for this feasibility study are semitranslucency, telangiectasia, ulcer, crust, and tumor border. Image processing methods used in this study include frequency analysis of the Fourier transform of the image, the Sun-Wee texture analysis algorithm, and several other image analysis techniques suitable for skin photographs. This image analysis software is designed for use with AI/DERM, an expert system that models diagnosis of skin tumors by dermatologists.
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Affiliation(s)
- R H Moss
- Department of Electrical Engineering, University of Missouri, Rolla 65401
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