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Gbegli E, Miremadi A, Serrao EM, Sadler TJ. Perforated Amyand hernia with an adenocarcinoma tumour presenting as a groin abscess. BJR Case Rep 2024; 10:uaae008. [PMID: 38529105 PMCID: PMC10962930 DOI: 10.1093/bjrcr/uaae008] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2023] [Revised: 01/30/2024] [Accepted: 02/17/2024] [Indexed: 03/27/2024] Open
Abstract
An Amyand hernia is an incarcerated inguinal hernia containing the appendix with or without appendicitis. This is a rare form of inguinal hernia, making up approximately 0.4%-1% of all cases. As with any hernia, this may become strangulated at any time, leading to the loss of blood supply and further development of gangrene and complications. Clinically, this can present in a manner indistinguishable from other types of inguinal hernias. In addition, the appendix can be affected by its own set of pathological processes, such as infection, inflammation, and malignancy. Not uncommonly both hernial and appendiceal complications coexist. The clinical diagnosis of an Amyand hernia remains challenging due to its low incidence and indistinct clinical presentation. At present, surgery is usually diagnostic and therapeutic. However, there is a growing number of recent reports showing the invaluable role of imaging on the diagnosis of Amyand hernias and associated complications. The correct and timely recognition of their imaging features including complications can optimize and expedite patient care by guiding diagnosis, treatment, and prognosis. Here, we report for the first time the radiological and pathological findings of a patient with a unique complicated Amyand hernia, which posed a diagnostic challenge for the clinical and radiological teams.
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Affiliation(s)
- Emmanuel Gbegli
- Department of Radiology, Addenbrooke’s Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge CB2 0QQ, United Kingdom
| | - Ahmad Miremadi
- Department of Histopathology, Addenbrooke’s Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge CB2 0QQ, United Kingdom
| | - Eva Mendes Serrao
- Department of Radiology, Addenbrooke’s Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge CB2 0QQ, United Kingdom
- Department of Radiology, University of Cambridge, Cambridge CB2 0QQ, United Kingdom
| | - Timothy J Sadler
- Department of Radiology, Addenbrooke’s Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge CB2 0QQ, United Kingdom
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Bentham MJ, Christopher HW, Borchert RJ, Thavakumar A, Riede P, Sadler TJ. Incidence and distribution of injuries associated with e-scooter use: a radiological perspective. Br J Radiol 2024; 97:567-573. [PMID: 38265291 DOI: 10.1093/bjr/tqad057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2023] [Revised: 09/19/2023] [Accepted: 12/04/2023] [Indexed: 01/25/2024] Open
Abstract
OBJECTIVES To investigate electric scooter (e-scooter)-associated radiological injury incidence and distribution of injuries. METHODS Retrospective cross-sectional study of radiological examinations related to e-scooter injuries at a major trauma centre in a small university city. The hospital radiology information system was searched for terms related to e-scooters between January 1, 2015, and October 31, 2022. E-scooter use was confirmed by review of the patients' electronic medical records. Specific injuries were divided based on site of injury using the Injury Severity Scale categorized groups. RESULTS A total of 568 radiological studies related to e-scooter injuries were identified on 340 distinct patients (56% male, with an average age of 28 years). Peak incidence of e-scooter-related injuries was seen in the summer months, after a local scooter sharing system was introduced in October 2020. A total of 149 patients had radiologically diagnosed injuries, with extremity injuries being most frequent (80%). Facial (8%), head/neck (8%), and thorax/abdomen (4%) were less common. Radial head fractures were the most common injury (n = 27). Thirteen patients had multiple sites of injury, four of which had both upper limb and facial bone fractures described. CONCLUSIONS We report a significant increase in radiological investigations and injuries in the context of e-scooter injuries, particularly since the introduction of an e-scooter sharing scheme. This study informs radiologists on common locations of injuries when reporting studies of patients that have had e-scooter-related injuries. ADVANCES IN KNOWLEDGE This is the first UK-based study providing a comprehensive radiological perspective of the impact of e-scooter use and associated distribution of injuries, adding important data for many cities that are currently undertaking review of their e-scooter sharing schemes.
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Affiliation(s)
- Michael J Bentham
- Department of Radiology, Cambridge University Hospitals NHS Foundation Trust, Cambridge CB2 0QQ, United Kingdom
| | - Holly W Christopher
- Department of Radiology, Cambridge University Hospitals NHS Foundation Trust, Cambridge CB2 0QQ, United Kingdom
| | - Robin J Borchert
- Department of Radiology, Cambridge University Hospitals NHS Foundation Trust, Cambridge CB2 0QQ, United Kingdom
- Department of Radiology, University of Cambridge School of Clinical Medicine, Cambridge CB2 0QQ, United Kingdom
| | - Arthikkaa Thavakumar
- Department of Radiology, Cambridge University Hospitals NHS Foundation Trust, Cambridge CB2 0QQ, United Kingdom
| | - Philipp Riede
- Department of Radiology, Cambridge University Hospitals NHS Foundation Trust, Cambridge CB2 0QQ, United Kingdom
| | - Timothy J Sadler
- Department of Radiology, Cambridge University Hospitals NHS Foundation Trust, Cambridge CB2 0QQ, United Kingdom
- Department of Radiology, University of Cambridge School of Clinical Medicine, Cambridge CB2 0QQ, United Kingdom
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Rooney S, Stavrou G, Sadler TJ, Oikonomou IM, Gourgiotis S. Gastric volvulus causing liver ischemia. ANZ J Surg 2023; 93:2776. [PMID: 37727040 DOI: 10.1111/ans.18702] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2023] [Accepted: 09/10/2023] [Indexed: 09/21/2023]
Affiliation(s)
- Siobhan Rooney
- Department of Radiology, Ninewells Hospital, Dundee, Scotland, UK
| | - George Stavrou
- Department of UGI Surgery, Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Timothy J Sadler
- Department of Radiology, Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Ilias-Marios Oikonomou
- Major Trauma Service, Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Stavros Gourgiotis
- Department of UGI Surgery, Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
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Borchert RJ, Hickman CR, Pepys J, Sadler TJ. Performance of ChatGPT on the Situational Judgement Test-A Professional Dilemmas-Based Examination for Doctors in the United Kingdom. JMIR Med Educ 2023; 9:e48978. [PMID: 37548997 PMCID: PMC10442724 DOI: 10.2196/48978] [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] [Subscribe] [Scholar Register] [Received: 05/16/2023] [Revised: 06/30/2023] [Accepted: 07/25/2023] [Indexed: 08/08/2023]
Abstract
BACKGROUND ChatGPT is a large language model that has performed well on professional examinations in the fields of medicine, law, and business. However, it is unclear how ChatGPT would perform on an examination assessing professionalism and situational judgement for doctors. OBJECTIVE We evaluated the performance of ChatGPT on the Situational Judgement Test (SJT): a national examination taken by all final-year medical students in the United Kingdom. This examination is designed to assess attributes such as communication, teamwork, patient safety, prioritization skills, professionalism, and ethics. METHODS All questions from the UK Foundation Programme Office's (UKFPO's) 2023 SJT practice examination were inputted into ChatGPT. For each question, ChatGPT's answers and rationales were recorded and assessed on the basis of the official UK Foundation Programme Office scoring template. Questions were categorized into domains of Good Medical Practice on the basis of the domains referenced in the rationales provided in the scoring sheet. Questions without clear domain links were screened by reviewers and assigned one or multiple domains. ChatGPT's overall performance, as well as its performance across the domains of Good Medical Practice, was evaluated. RESULTS Overall, ChatGPT performed well, scoring 76% on the SJT but scoring full marks on only a few questions (9%), which may reflect possible flaws in ChatGPT's situational judgement or inconsistencies in the reasoning across questions (or both) in the examination itself. ChatGPT demonstrated consistent performance across the 4 outlined domains in Good Medical Practice for doctors. CONCLUSIONS Further research is needed to understand the potential applications of large language models, such as ChatGPT, in medical education for standardizing questions and providing consistent rationales for examinations assessing professionalism and ethics.
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Affiliation(s)
- Robin J Borchert
- Department of Radiology, University of Cambridge, Cambridge, United Kingdom
- Department of Radiology, Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom
| | - Charlotte R Hickman
- Department of General Medicine, Lister Hospital, East and North Hertfordshire NHS Trust, Stevenage, United Kingdom
| | - Jack Pepys
- Department of Biomedical Sciences, Humanitas University, Milan, Italy
| | - Timothy J Sadler
- Department of Radiology, Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom
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Wetscherek MTA, McNaughton E, Majcher V, Wetscherek A, Sadler TJ, Alsinbili A, Teh WH, Moore SD, Patel N, Smith WPW, Krishnan U. Incidental coronary artery calcification on non-gated CT thorax correlates with risk of cardiovascular events and death. Eur Radiol 2023:10.1007/s00330-023-09428-z. [PMID: 36705681 PMCID: PMC9881510 DOI: 10.1007/s00330-023-09428-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [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: 09/03/2022] [Revised: 01/02/2023] [Accepted: 01/04/2023] [Indexed: 01/28/2023]
Abstract
OBJECTIVES To assess coronary artery calcification (CAC) on non-contrast non-ECG-gated CT thorax (NC-NECG-CTT) and to evaluate its correlation with short-term risk of cardiovascular disease (CVD) events and death. METHODS Single-institution retrospective study including all patients 40-70 years old who underwent NC-NECG-CTT over a period of 6 months. Individuals with known CVD were excluded. The presence of CAC was assessed and quantified by the Agatston score (CACS). CAC severity was defined as mild (< 100), moderate (100-400), or severe (> 400). CVD events (including CVD death, myocardial infarction, revascularisation procedures, ischaemic stroke, acute peripheral atherosclerotic ischaemia), and all-cause mortality over a median of 3.5 years were recorded. Cox proportional-hazards regression modelling was performed including CACS, age, gender and CVD risk factors (smoking, hypertension, diabetes mellitus, dyslipidaemia, and family history of CVD). RESULTS Of the total 717 eligible cases, 325 (45%) had CAC. In patients without CAC, there was only one CVD event, compared to 26 CVD events including 5 deaths in patients with CAC. The presence and severity of CAC correlated with CVD events (p < 0.001). A CACS > 100 was significantly associated with both CVD events, hazard ratio (HR) 5.74, 95% confidence interval: 2.19-15.02; p < 0.001, and all-cause mortality, HR 1.7, 95% CI: 1.08-2.66; p = 0.02. Ever-smokers with CAC had a significantly higher risk for all-cause mortality compared to never-smokers (p = 0.03), but smoking status was not an independent predictor for CVD events in any subgroup category of CAC severity. CONCLUSIONS The presence and severity of CAC assessed on NC-NECG-CTT correlates with short-term cardiovascular events and death. KEY POINTS • Patients aged 40-70 years old without known CVD but with CAC on NC-NECG-CTT have a higher risk of CVD events compared to those without CAC. • CAC (Agatston) score above 100 confers a 5.7-fold increase in the risk of short-term CVD events in these patients. • The presence and severity of CAC on NC-NECG-CTT may have prognostic and therapeutic implications.
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Affiliation(s)
- Maria T A Wetscherek
- Department of Radiology, Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Hills Rd, Cambridge, CB2 0QQ, UK.
| | - Edwina McNaughton
- Department of Cardiology, Royal Papworth Hospital NHS Foundation Trust, Papworth Rd, Trumpington, Cambridge, CB2 0AY, UK
| | - Veronika Majcher
- Department of Radiology, Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Hills Rd, Cambridge, CB2 0QQ, UK
| | - Andreas Wetscherek
- Joint Department of Physics, The Institute of Cancer Research and The Royal Marsden NHS Foundation Trust, 15 Cotswold Rd, London, SM2 5NG, UK
| | - Timothy J Sadler
- Department of Radiology, Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Hills Rd, Cambridge, CB2 0QQ, UK
| | - Ahmed Alsinbili
- Department of Cardiology, Royal Papworth Hospital NHS Foundation Trust, Papworth Rd, Trumpington, Cambridge, CB2 0AY, UK
| | - Wen Hui Teh
- Department of Cardiology, Royal Papworth Hospital NHS Foundation Trust, Papworth Rd, Trumpington, Cambridge, CB2 0AY, UK
| | - Samuel D Moore
- School of Clinical Medicine, University of Cambridge, Hills Rd, Cambridge, CB2 0SP, UK
| | - Nirav Patel
- School of Clinical Medicine, University of Cambridge, Hills Rd, Cambridge, CB2 0SP, UK
| | - William P W Smith
- School of Clinical Medicine, University of Cambridge, Hills Rd, Cambridge, CB2 0SP, UK
| | - Unni Krishnan
- Department of Cardiology, Royal Papworth Hospital NHS Foundation Trust, Papworth Rd, Trumpington, Cambridge, CB2 0AY, UK
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Serrao EM, Costa AM, Ferreira S, McMorran V, Cargill E, Hough C, Shaw AS, O'Carrigan B, Parkinson CA, Corrie PG, Sadler TJ. The different faces of metastatic melanoma in the gastrointestinal tract. Insights Imaging 2022; 13:161. [PMID: 36195726 PMCID: PMC9532488 DOI: 10.1186/s13244-022-01294-5] [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: 06/14/2022] [Accepted: 09/04/2022] [Indexed: 11/10/2022] Open
Abstract
Melanoma is the most aggressive form of skin cancer, with tendency to spread to any organ of the human body, including the gastrointestinal tract (GIT). The diagnosis of metastases to the GIT can be difficult, as they may be clinically silent for somewhile and may occur years after the initial melanoma diagnosis. CT imaging remains the standard modality for staging and surveillance of melanoma patients, and in most cases, it will be the first imaging modality to identify GIT lesions. However, interpretation of CT studies in patients with melanoma can be challenging as lesions may be subtle and random in distribution, as well as sometimes mimicking other conditions. Even so, early diagnosis of GIT metastases is critical to avoid emergency hospitalisations, whilst surgical intervention can be curative in some cases. In this review, we illustrate the various imaging presentations of melanoma metastases within the GIT, discuss the clinical aspects and offer advice on investigation and management. We offer tips intended to aid radiologists in their diagnostic skills and interpretation of melanoma imaging scans.
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Affiliation(s)
- Eva Mendes Serrao
- Department of Radiology, Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK. .,Department of Radiology, University of Cambridge, Box 218, Cambridge, CB2 0QQ, UK.
| | - Ana Maria Costa
- Department of Radiology, Hospital Fernando Fonseca, Amadora, Portugal
| | - Sergio Ferreira
- Department of Radiology, Hospital Fernando Fonseca, Amadora, Portugal
| | - Victoria McMorran
- Department of Oncology, Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Emma Cargill
- Department of Oncology, Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Caroline Hough
- Department of Oncology, Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Ashley S Shaw
- Department of Radiology, Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Brent O'Carrigan
- Department of Oncology, Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Christine A Parkinson
- Department of Oncology, Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Pippa G Corrie
- Department of Oncology, Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Timothy J Sadler
- Department of Radiology, Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
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Mendes Serrao E, Joslin E, McMorran V, Hough C, Palmer C, McDonald S, Cargill E, Shaw AS, O'Carrigan B, Parkinson CA, Corrie PG, Sadler TJ. The forgotten appearance of metastatic melanoma in the small bowel. Cancer Imaging 2022; 22:27. [PMID: 35701818 PMCID: PMC9195247 DOI: 10.1186/s40644-022-00463-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2022] [Accepted: 05/19/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Melanoma is the most aggressive form of skin cancer, with a tendency to metastasise to any organ of the human body. While the most common body organs affected include liver, lungs, brain and soft tissues, spread to the gastrointestinal tract is not uncommon. In the bowel, it can present with a multitude of imaging appearances, more rarely as an aneurysmal dilatation. This appearance is classically associated with lymphoma, but it has more rarely been associated with other forms of malignancy. CASE PRESENTATION We report a case series of three patients with aneurysmal dilatation in the small bowel (SB) confirmed to be due to metastatic melanoma (MM). All patients had non-specific symptoms; most times being attributed initially to causes other than melanoma. On CT the identified aneurysmal SB dilatations were diagnosed as presumed lymphoma in all cases. In two cases, the aneurysmal dilatation was the first presentation of metastatic disease and in two of the cases more than one site of the gastrointestinal tract was concomitantly involved. All patients underwent surgical resection with histological confirmation of MM. CONCLUSIONS Recognition of unusual SB presentation of MM, such as aneurysmal SB dilatation, is important to expedite diagnosis, provide appropriate treatment, and consequently improve quality of life and likely survival of these patients. As the most common cancer to metastasise to the SB and as a known imaging mimicker, MM should remain in any radiologist's differential diagnosis for SB lesions with aneurysmal dilatation.
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Affiliation(s)
- Eva Mendes Serrao
- Department of Radiology, Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK. .,Department of Radiology, University of Cambridge, Box 218, Cambridge, CB2 0QQ, UK.
| | - Emily Joslin
- Department of Pathology, Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Victoria McMorran
- Department of Oncology, Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Caroline Hough
- Department of Oncology, Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Cheryl Palmer
- Department of Oncology, Hinchingbrooke Hospital, Huntingdon, UK
| | - Sarah McDonald
- Department of Pathology, Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Emma Cargill
- Department of Oncology, Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Ashley S Shaw
- Department of Radiology, Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Brent O'Carrigan
- Department of Oncology, Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Christine A Parkinson
- Department of Oncology, Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Pippa G Corrie
- Department of Oncology, Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Timothy J Sadler
- Department of Radiology, Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
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Wetscherek MTA, Sadler TJ, Lee JYJ, Karia S, Babar JL. Active pulmonary tuberculosis: something old, something new, something borrowed, something blue. Insights Imaging 2022; 13:3. [PMID: 35001143 PMCID: PMC8743064 DOI: 10.1186/s13244-021-01138-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2021] [Accepted: 12/01/2021] [Indexed: 11/26/2022] Open
Abstract
Tuberculosis remains a major global health issue affecting all countries and age groups. Radiology plays a crucial role in the diagnosis and management of pulmonary tuberculosis (PTB). This review aims to improve understanding and diagnostic value of imaging in PTB. We present the old, well-established findings ranging from primary TB to the common appearances of post-primary TB, including dissemination with tree-in-bud nodularity, haematogenous dissemination with miliary nodules and lymphatic dissemination. We discuss new concepts in active PTB with special focus on imaging findings in immunocompromised individuals. We illustrate PTB appearances borrowed from other diseases in which the signs were initially described: the reversed halo sign, the galaxy sign and the cluster sign. There are several radiological signs that have been shown to correlate with positive or negative sputum smears, and radiologists should be aware of these signs as they play an important role in guiding the need for isolation and empirical anti-tuberculous therapy.
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Affiliation(s)
- Maria T A Wetscherek
- Department of Radiology, Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Hills Rd, Cambridge, CB2 0QQ, UK. .,Department of Pneumology, Iuliu Hatieganu University of Medicine and Pharmacy, 8 Victor Babeș Street, 400000, Cluj-Napoca, Romania.
| | - Timothy J Sadler
- Department of Radiology, Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Hills Rd, Cambridge, CB2 0QQ, UK
| | - Janice Y J Lee
- Department of Radiology, Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Hills Rd, Cambridge, CB2 0QQ, UK
| | - Sumit Karia
- Department of Radiology, Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Hills Rd, Cambridge, CB2 0QQ, UK
| | - Judith L Babar
- Department of Radiology, Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Hills Rd, Cambridge, CB2 0QQ, UK
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Affiliation(s)
- Timothy J Sadler
- Department of Radiology, Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Philipp Riede
- Department of Radiology, Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
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Vaid D, Majcher V, Heptonstall N, Sadler TJ, Winterbottom AP. Images of the month 2: Pulmonary artery pseudoaneurysm formation within uterine leiomyosarcoma metastases. Clin Med (Lond) 2021; 21:e533-e534. [PMID: 38594862 DOI: 10.7861/clinmed.2021-0494] [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] [Indexed: 11/27/2022]
Abstract
We present a rare case of pulmonary artery pseudoaneurysm formation in leiomyosarcoma metastases with evidence of acute bleeding and subsequent interventional radiological management.
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Zhang TT, Sadler TJ, Whitley S, Brais R, Godfrey E. The CT fish mouth ampulla sign: a highly specific finding in main duct and mixed intraductal papillary mucinous neoplasms. Br J Radiol 2019; 92:20190461. [PMID: 31430199 DOI: 10.1259/bjr.20190461] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
OBJECTIVE Main duct and mixed intraductal papillary mucinous neoplasms (IPMN) are pre-malignant cystic pancreatic neoplasms associated with pancreatic duct dilatation. Distinguishing these from benign causes of pancreatic duct dilatation is important in order to allow appropriate surveillance or surgery. A patulous duodenal papilla with extrusion of mucus at endoscopic evaluation, the endoscopic fish mouth ampulla (E-FMA) sign, is reported in main duct and mixed IPMN. We aimed to establish whether a CT correlate (CT-FMA) of this sign exists and whether this was associated with the presence of invasion or high-grade dysplasia. We defined the CT-FMA sign as an uninterrupted column of water attenuation material running from the pancreatic duct to the duodenal lumen. METHODS A retrospective, blinded review of 44 patients with histologically confirmed IPMN and 87 age-matched controls with pancreatic duct dilatation on CT was undertaken. A case-control series matched for the degree of pancreatic duct dilatation was used to compare the rates of invasion or high-grade dysplasia between main duct and mixed IPMN patients, with and without a CT-FMA sign. RESULTS The CT-FMA sign could be identified in 18.5% patients with main duct/mixed IPMN with specificity 100%, positive predictive value 100% and negative predictive value 79.8%. A significant association was found between CT-FMA in main duct/mixed IPMN compared to controls, but not with the presence of high-grade dysplasia or invasion. CONCLUSIONS The CT-FMA sign is a newly reported, highly specific sign of MD and mixed IPMN. ADVANCES IN KNOWLEDGE If a fish mouth ampulla is identified at CT, a diagnosis of main duct or mixed IPMN is highly likely.
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Affiliation(s)
- Ting Ting Zhang
- Department of Radiology, Brighton and Sussex University Hospitals, Brighton, United Kingdom
| | - Timothy J Sadler
- Department of Radiology, Royal Papworth Hospital, Cambridge, United Kingdom
| | - Siobhan Whitley
- Department of Radiology, West Suffolk Hospital, Bury St Edmunds, United Kingdom
| | - Rebecca Brais
- Department of Pathology, Cambridge University Hospitals, Cambridge, United Kingdom
| | - Edmund Godfrey
- Department of Radiology, Cambridge University Hospitals, Cambridge, United Kingdom
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Coles AJ, Azzopardi L, Kousin-Ezewu O, Mullay HK, Thompson SA, Jarvis L, Davies J, Howlett S, Rainbow D, Babar J, Sadler TJ, Brown JWL, Needham E, May K, Georgieva ZG, Handel AE, Maio S, Deadman M, Rota I, Holländer G, Dawson S, Jayne D, Seggewiss-Bernhardt R, Douek DC, Isaacs JD, Jones JL. Keratinocyte growth factor impairs human thymic recovery from lymphopenia. JCI Insight 2019; 5:125377. [PMID: 31063156 PMCID: PMC6629095 DOI: 10.1172/jci.insight.125377] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [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: 02/02/2023] Open
Abstract
BACKGROUND The lymphocyte-depleting antibody alemtuzumab is a highly effective treatment of relapsing-remitting multiple sclerosis (RRMS); however 50% of patients develop novel autoimmunity post-treatment. Most at risk are individuals who reconstitute their T-cell pool by proliferating residual cells, rather than producing new T-cells in the thymus; raising the possibility that autoimmunity might be prevented by increasing thymopoiesis. Keratinocyte growth factor (palifermin) promotes thymopoiesis in non-human primates. METHODS Following a dose-tolerability sub-study, individuals with RRMS (duration ≤10 years; expanded disability status scale ≤5·0; with ≥2 relapses in the previous 2 years) were randomised to placebo or 180mcg/kg/day palifermin, given for 3 days immediately prior to and after each cycle of alemtuzumab, with repeat doses at M1 and M3. The interim primary endpoint was naïve CD4+ T-cell count at M6. Exploratory endpoints included: number of recent thymic-emigrants (RTEs) and signal-joint T-cell receptor excision circles (sjTRECs)/mL of blood. The trial primary endpoint was incidence of autoimmunity at M30. FINDINGS At M6, individuals receiving palifermin had fewer naïve CD4+T-cells (2.229x107/L vs. 7.733x107/L; p=0.007), RTEs (16% vs. 34%) and sjTRECs/mL (1100 vs. 3396), leading to protocol-defined termination of recruitment. No difference was observed in the rate of autoimmunity between the two groupsConclusion: In contrast to animal studies, palifermin reduced thymopoiesis in our patients. These results offer a note of caution to those using palifermin to promote thymopoiesis in other settings, particularly in the oncology/haematology setting where alemtuzumab is often used as part of the conditioning regime. TRIAL REGISTRATION ClinicalTrials.gov NCT01712945Funding: MRC and Moulton Charitable Foundation.
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Affiliation(s)
- Alasdair J Coles
- Department of Clinical Neurosciences, University of Cambridge, Cambridge, United Kingdom
| | - Laura Azzopardi
- Department of Clinical Neurosciences, University of Cambridge, Cambridge, United Kingdom
| | - Onajite Kousin-Ezewu
- Department of Clinical Neurosciences, University of Cambridge, Cambridge, United Kingdom
| | - Harpreet Kaur Mullay
- Department of Clinical Neurosciences, University of Cambridge, Cambridge, United Kingdom
| | - Sara Aj Thompson
- Department of Clinical Neurosciences, University of Cambridge, Cambridge, United Kingdom
| | - Lorna Jarvis
- Department of Clinical Neurosciences, University of Cambridge, Cambridge, United Kingdom
| | - Jessica Davies
- Department of Clinical Neurosciences, University of Cambridge, Cambridge, United Kingdom
| | - Sarah Howlett
- Department of Clinical Neurosciences, University of Cambridge, Cambridge, United Kingdom
| | - Daniel Rainbow
- Department of Clinical Neurosciences, University of Cambridge, Cambridge, United Kingdom
| | - Judith Babar
- Department of Clinical Neurosciences, University of Cambridge, Cambridge, United Kingdom
| | - Timothy J Sadler
- Department of Clinical Neurosciences, University of Cambridge, Cambridge, United Kingdom
| | - J William L Brown
- Department of Clinical Neurosciences, University of Cambridge, Cambridge, United Kingdom
| | - Edward Needham
- Department of Clinical Neurosciences, University of Cambridge, Cambridge, United Kingdom
| | - Karen May
- Department of Clinical Neurosciences, University of Cambridge, Cambridge, United Kingdom
| | - Zoya G Georgieva
- Department of Clinical Neurosciences, University of Cambridge, Cambridge, United Kingdom
| | | | - Stefano Maio
- Department of Paediatrics, University of Oxford, Oxford, United Kingdom
| | - Mary Deadman
- Department of Paediatrics, University of Oxford, Oxford, United Kingdom
| | - Ioanna Rota
- Department of Paediatrics, University of Oxford, Oxford, United Kingdom
| | - Georg Holländer
- Department of Paediatrics, University of Oxford, Oxford, United Kingdom
| | - Sarah Dawson
- Cambridge Clinical Trials Unit, Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom.,Medical Research Council (MRC) Biostatistics Unit, Cambridge Institute of Public Health, Cambridge, United Kingdom
| | - David Jayne
- Department of Clinical Neurosciences, University of Cambridge, Cambridge, United Kingdom
| | - Ruth Seggewiss-Bernhardt
- University Hospital of Würzburg, Würzburg, Germany.,Department of Hematology/Oncology, Soziastiftung Bamberg, Bamberg, Germany
| | - Daniel C Douek
- National Institute of Allergy and Infectious Diseases, NIH, Bethesda, Maryland, USA
| | - John D Isaacs
- Institute of Cellular Medicine, Newcastle University, and Musculoskeletal Unit, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, United Kingdom
| | - Joanne L Jones
- Department of Clinical Neurosciences, University of Cambridge, Cambridge, United Kingdom
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13
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Cheng AJL, Sadler TJ. Unexpected case of pneumomediastinum and subcutaneous emphysema: primary or secondary aetiology? BMJ Case Rep 2018; 2018:bcr-2018-224528. [PMID: 29674403 DOI: 10.1136/bcr-2018-224528] [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] [Indexed: 11/03/2022] Open
Abstract
A 77-year-old man was admitted with a relapse of antineutrophil cytoplasmic antibody-positive vasculitis with pulmonary involvement and acute kidney injury. There was a background of pulmonary fibrosis (non-specific interstitial pneumonia type pattern) and superadded pulmonary haemorrhage, acute pulmonary oedema and sepsis. The patient was intubated for 4 days and remained dependent on high flow oxygen and continuous positive airway pressure after extubation. A chest radiograph performed 2 weeks after extubation demonstrated unexpected, extensive pneumomediastinum and subcutaneous emphysema. This was confirmed on CT which raised the possibility of a tracheal defect at the level of the prior endotracheal tube cuff position. Tracheal injury was considered clinically unlikely due to the considerable interval since extubation and a short, uneventful intubation period. The cardiothoracic team recommended a diagnostic bronchoscopy but this was felt too high risk by the clinical team. The cause of pneumomediastinum and subcutaneous emphysema remained indeterminate.
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14
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Horvat N, Godfrey EM, Sadler TJ, Hechtman JF, Tang LH, Sigel CS, Monti S, Mannelli L. Subclinical focal Cholangitis mimicking liver metastasis in asymptomatic patients with history of pancreatic Ductal Adenocarcinoma and Biliary tree intervention. Cancer Imaging 2017; 17:21. [PMID: 28709465 PMCID: PMC5512934 DOI: 10.1186/s40644-017-0124-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [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: 05/15/2017] [Accepted: 07/05/2017] [Indexed: 11/30/2022] Open
Abstract
Background Cholangitis is an inflammatory process of the biliary tract with a wide range of clinical manifestations and it is not always considered in the differential diagnosis in asymptomatic patients. To the best of our knowledge there is no previous report in the English literature of focal cholangitis manifesting exclusively as liver parenchymal changes mimicking liver metastasis in asymptomatic patients with pancreatic ductal adenocarcinoma (PDAC) and history of manipulation of the biliary tree. The purpose of this article is to present six cases of subclinical focal cholangitis mimicking liver metastasis in asymptomatic patients with history of PDAC and biliary tree intervention. Case presentation There are six cases with new hepatic lesions detected on follow-up scans in asymptomatic patients with history of PDAC and manipulation of biliary tree. Overall seven lesions were detected, all of them were on the liver periphery, five were hypovascular and two were hypervascular. None of those patients had elevation of CA 19.9 compared with the previous exams. The three patients that had magnetic resonance imaging presented restriction on diffusion weighted imaging and high signal intensity on T2-weighted image. Two patients underwent liver biopsy, which showed only inflammatory changes. All patients were treated with antibiotics and underwent imaging follow-up, which demonstrated resolution of the lesions. None of the patients showed imaging or clinical signs of disease progression during this interval. Conclusion Radiologists and oncologists need to be aware of the possibility of focal cholangitis causing hepatic lesions mimicking neoplasia in patients with history of biliary tree intervention, even in the absence of clinical symptoms.
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Affiliation(s)
- Natally Horvat
- Department of Radiology, Memorial Sloan Kettering Cancer Center, 300 East 66th Street, New York, NY, 10021, USA.,Department of Radiology, Hospital Sírio-Libanês, Adma Jafet 91, São Paulo, SP, 01308050, Brazil.,Department of Radiology, Universidade de São Paulo, Dr. Enéas de Carvalho Aguiar, São Paulo, SP, 05403900, Brazil
| | - Edmund M Godfrey
- Department of Radiology, Addenbrooke's Hospital, Cambridge University NHS Foundation Trust, Hills Road, Cambridge, CB2 0QQ, UK
| | - Timothy J Sadler
- Department of Radiology, Addenbrooke's Hospital, Cambridge University NHS Foundation Trust, Hills Road, Cambridge, CB2 0QQ, UK
| | - Jaclyn F Hechtman
- Department of Pathology, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY, 10065, USA
| | - Laura H Tang
- Department of Pathology, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY, 10065, USA
| | - Carlie S Sigel
- Department of Pathology, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY, 10065, USA
| | - Serena Monti
- IRCCS SDN, Via E. Gianturco, 113, 80143, Naples, Italy
| | - Lorenzo Mannelli
- Department of Radiology, Memorial Sloan Kettering Cancer Center, 300 East 66th Street, New York, NY, 10021, USA.
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15
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Al-Lamki RS, Sadler TJ, Wang J, Reid MJ, Warren AY, Movassagh M, Lu W, Mills IG, Neal DE, Burge J, Vandenebeele P, Pober JS, Bradley JR. Tumor necrosis factor receptor expression and signaling in renal cell carcinoma. Am J Pathol 2010; 177:943-54. [PMID: 20566746 DOI: 10.2353/ajpath.2010.091218] [Citation(s) in RCA: 53] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Clear cell renal cell carcinoma (ccRCC), a tubular epithelial cell (TEC) malignancy, frequently secretes tumor necrosis factor (TNF). TNF signals via two distinct receptors (TNFRs). TNFR1, expressed in normal kidney primarily on endothelial cells, activates apoptotic signaling kinase 1 and nuclear factor-kappaB (NF-kappaB) and induces cell death, whereas TNFR2, inducibly expressed on endothelial cells and on TECs by injury, activates endothelial/epithelial tyrosine kinase (Etk), which trans-activates vascular endothelial growth factor receptor 2 (VEGFR2) to promote cell proliferation. We investigated TNFR expression in clinical samples and function in short-term organ cultures of ccRCC tissue treated with wild-type TNF or specific muteins selective for TNFR1 (R1-TNF) or TNFR2 (R2-TNF). There is a significant increase in TNFR2 but not TNFR1 expression on malignant TECs that correlates with increasing malignant grade. In ccRCC organ cultures, R1-TNF increases TNFR1, activates apoptotic signaling kinase and NF-kappaB, and promotes apoptosis in malignant TECs. R2-TNF increases TNFR2, activates NF-kappaB, Etk, and VEGFR2 and increases entry into the cell cycle. Wild-type TNF induces both sets of responses. R2-TNF actions are blocked by pretreatment with a VEGFR2 kinase inhibitor. We conclude that TNF, acting through TNFR2, is an autocrine growth factor for ccRCC acting via Etk-VEGFR2 cross-talk, insights that may provide a more effective therapeutic approach to this disease.
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Affiliation(s)
- Rafia S Al-Lamki
- Department of Medicine, University of Cambridge, Addenbrooke's Hospital, Cambridge, UK.
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16
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Gerber SA, Yatsula B, Maier CL, Sadler TJ, Whittaker LW, Pober JS. Interferon-gamma induces prolyl hydroxylase (PHD)3 through a STAT1-dependent mechanism in human endothelial cells. Arterioscler Thromb Vasc Biol 2009; 29:1363-9. [PMID: 19574556 DOI: 10.1161/atvbaha.109.192542] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
OBJECTIVE We previously reported that interferons (IFNs) regulate transcription of HIF-1alpha in human endothelial cells (ECs), linking immunity and hypoxia. Prolyl hydroxylases (PHDs) regulate expression of HIF-1alpha in response to hypoxia. We examined whether IFNs affect PHD expression and whether PHDs regulate the EC response to IFNs. METHODS AND RESULTS Human cell cultures were treated with various cytokines, and PHD expression was examined using qRT-PCR and immunoblotting. IFNgamma and, to a lesser extent, IFNalpha significantly induced PHD3, but not PHD1 or 2, mRNA, and protein expression selectively in ECs directly via a JAK/STAT1 pathway as demonstrated by pharmacological inhibition, siRNA knockdown, and chromatin immunoprecipitation. Inhibition of PHD activity with dimethyloxallyl glycine or desferroxamine reduced IFNg-dependent responses in these same cells. CONCLUSIONS IFNgamma induces PHD3 through a JAK/STAT1-dependent mechanism in human ECs. Induction is independent of HIF-1alpha and may contribute to expression of IFNgamma-dependent genes.
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Affiliation(s)
- Scott A Gerber
- Department of Immunobiology, Yale University School of Medicine, New Haven, CT 06520-8089 , USA
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17
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Abstract
Wiseana nucleopolyhedrovirus (NPV) is the major pathogen of the New Zealand endemic pasture pest, Wiseana spp. To characterize this potential biological control agent, the genome of a virus isolated from Wiseana signata was purified and cloned. The complete genome was cloned as BamHI or HindIII restriction fragments, which were mapped by Southern hybridization and restriction analysis. To verify the physical map, the junctions between all HindIII fragments were confirmed by sequencing. The viral genome was estimated to be 128 kbp. Sequence data generated at the termini of cloned restriction fragments were compared to sequence databases to identify putative gene homologues. Seventeen putative ORFs, which were homologous to other baculoviral sequences, were identified. These putative ORFs were located on the Wiseana NPV physical map and their distribution was compared to genetic maps of NPVs isolated from Autographa californica, Orgyia pseudotsugata and Lymantria dispar. Although the virus from W. signata was significantly different from these other NPVs, a core region of the viral genome was conserved.
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Affiliation(s)
- T J Sadler
- Department of Microbiology, School of Medical Sciences, Otago University, PO Box 56, Dunedin, New Zealand
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