Hajra Idrees, MBBS*, Raza Zarrar, MBBS, Bilal Mujtaba and MD
Published on: 8th November, 2022
Introduction: In recent years the increased utilization of imaging modalities has led to an accelerated diagnosis of renal masses. Initial diagnoses and staging are commonly done with the abdominal Computed Tomography (CT). This study evaluates the various aspects to consider when utilizing CT scan for the diagnosis of renal masses.Discussion: CT scan is the most important imaging modality to evaluate renal neoplasms. Postcontrast acquisitions can be tailored according to the indication for the study. This alongside various techniques, imaging modalities and classification systems may help differentiate the malignant Renal Cell Carcinoma, from benign or metastatic lesions, lymphomas or renal pseudotumor. Finally CT can also be utilized alongside other tools for staging the tumor. Conclusion: Certain CT imaging features are pertinent to evaluate the malignancy potential of renal lesions. However the CT alone may be inconclusive in diagnosing the majority of renal neoplasms, excluding AML with macroscopic fat. Hence it is recommended that the CT aid additional imaging modalities and tools to reach an accurate diagnosis.
Andre Calixte*, Schan Lartigue, Scott McGaugh, Michael Mathelier, Anjali Patel, Mohammad Reza Hosseini Siyanaki, Kevin Pierre and Brandon Lucke-Wold
Published on: 20th June, 2023
Neurointerventional Radiology (NIR), encompassing neuroendovascular surgery, endovascular neurosurgery, and interventional neurology, is an innovative and rapidly evolving multidisciplinary specialty focused on minimally invasive therapies for a wide range of neurological disorders. This review provides a comprehensive overview of NIR, discussing the three routes into the field, highlighting their distinct training paradigms, and emphasizing the importance of unified approaches through organizations like the Society of Neurointerventional Surgery (SNIS).The paper explores the benefits of co-managed care and its potential to improve patient outcomes, as well as the role of interdisciplinary collaboration and cross-disciplinary integration in advancing the field. We discuss the various contributions of neurosurgery, radiology, and neurology to cerebrovascular surgery, aiming to inform and educate those interested in pursuing a career in neurointervention. Additionally, the review examines the adoption of innovative technologies such as robotic-assisted techniques and artificial intelligence in NIR, and their implications for patient care and the future of the specialty. By presenting a comprehensive analysis of the field of neurointervention, we hope to inspire those considering a career in this exciting and rapidly advancing specialty, and underscore the importance of interdisciplinary collaboration in shaping its future.
Saber A Amin, Morshed Alam, Bangchen Wang, Weining Zhen, Chi Lin, Apar Kishor Ganti, Vinicius Ernani, Alissa Marr, Tony JC Wang, Simon K Cheng, Michael Baine and Chi Zhang*
Published on: 24th June, 2023
Purpose: Stereotactic body radiation therapy (SBRT) has emerged as an alternative to surgery for patients with inoperable early-stage non-small cell lung cancer (NSCLC). The majority of inoperable NSCLC patients are elderly and frequently have comorbidities including cardiovascular diseases for which they frequently receive angiotensin receptor blockers (ARBs) or angiotensin-converting enzyme inhibitors (ACEIs). The interactions of these medications with SBRT are not clear. The objective of the current study is to investigate the interaction of ARBs and ACEIs with SBRT for the outcomes of early-stage NSCLC. Methods and Materials: A retrospective chart review of patients treated with SBRT for Stage I and II NSCLC (AJCC 7th edition) at a single institution between 2006 and 2017 was conducted. Information on the use of ARBs, ACEIs, demographics, and tumor-related factors was collected. Kaplan-Meier and Cox proportional hazard analyses were performed to assess the impact of ARBs and ACEIs combined with SBRT respectively on the treatment outcomes of these patients. Results: In total, 116 patients were included in the study, among whom 38/116 (32.76%) received ACEIs, and 20/116 (17.24%) received ARBs. In the multivariable analysis, the use of ARBs, but not ACEIs, with SBRT, was significantly associated with the increased risk of dissemination (Hazard Ratio (HR): 2.97; CI: 1.40-6.27; p < 0.004) compared to SBRT without ARBs. The tumor size of > = 3 cm was associated with significantly decreased time to local failure and OS compared to tumor size <3cm. Conclusion: In the current retrospective study, the use of ARBs, in combination with SBRT, was associated with a significantly increased risk of disease dissemination in early-stage NSCLC compared to SBRT alone. The findings warrant further investigations on the concurrent use of ARBs, ACEIs, and other medicines used for chronic diseases with SBRT for early-stage NSCLC.
A 27-year-old pregnant woman presented with acute pyelonephritis for the first time in her pregnancy. We admitted the patient for treatment. On the second day, her fetus had bradycardia as a result of maternal hypothermia. Infusion of warmed fluid and providing a warm blanket were the definite treatment in this case. However, the fetal heart rate gradually returned to normal after rewarming the patient. We discharged the patient in a good state after one week. No complications were noticed.
Maximilian Reinhold*, Johannes Bonacker, Tobias Driesen and Wolfgang Lehmann
Published on: 18th November, 2022
Purpose: The extrusion of implant material is a rare complication but has been reported in several cases following anterior cervical spine surgery. A posterior spontaneous percutaneous rod extrusion after rigid occipitocervical (OC) instrumentation (screw and rod construct) has not been reported yet. The authors discuss potential complications after cervical spine surgery and its clinical management.Methods: This is a case report of a 56-year-old patient after posterior OC spine surgery with initially unobserved implant failure and posterior percutaneous rod extrusion. The implant failure with a missing rod has been documented 4 years later during a routine follow-up visit.Results: At the four-year follow-up, the asymptomatic patient presented with a stable occipitocervical junction and an improved range of motion after generalized sepsis with an epidural spinal abscess, decompression and posterior OC instrumentation. A computed tomography scan of the implant failure of a broken rod was noticed two years postoperatively. The patient failed to return to the clinic. For years postoperatively he returned to the clinic and the broken rod could not be detectable in-situ on the X-rays anymore. Conclusion: The posterior percutaneous rod extrusion following an OC instrumentation not noticed by the patient, is a very rare complication that has not been described in the literature yet. Once seen back in the clinic, the patient unexpectedly reported an improved ROM without neck pain. Usually, revision surgery or implant removal is recommended if an implant failure is documented.
Environmental and behavioral factors are very important for exposure to airborne SARS-CoV-2. Indoor environments are related to infection events, including super-spreader events and outbreaks. Indoor, poorly ventilated, and crowded areas, such as restaurants, cinemas, and bars can be effective in the accumulation of aerosols full of viruses, especially if people are in conversations and stay there for a long time period. At longer distances (more than 1.5 meters), small aerosols that can stay in the air for a longer period of time are dominant. The super-spreader events in which people have been infected at a distance away show that this remote transmission occurs. The exposure risk to longer intervals is likely to be more in domestic environments and indoor spaces that lack sufficient ventilation. Layer interventions are of fundamental importance. Therefore, it is important to take preventive measures as much as possible and follow them as carefully as possible, because no intervention alone will be effective in eliminating the risk. These include spacing, lining, hand hygiene, filtration, and ventilation.
Simmi Patel*, Sarah E Wheeler, Adam Anderson, Lisa Pinto and Michael R Shurin
Published on: 23rd November, 2022
Determining the extent of immunity induced by booster doses of COVID-19 vaccinations is crucial for informing recommendations for booster dose regimens as well as constant adjustments of immunization strategies amongst different groups of people within the population. The study involved 31 healthy volunteers (majority were healthcare professionals) who completed either vaccination course with Pfizer or Moderna mRNA vaccines and received a third dose of the vaccine. Here we report results on the evaluation of an antibody response to four different SARS-CoV-2 antigens: RBD, S1, S2 and nucleocapsid prior to third dose and two and four weeks after a booster vaccination. We detected a peak of high titers of antibodies after the third dose with a gradual decline after four weeks. No significant differences were seen between the two vaccines in terms of antibody response. There were no gender discrepancies between the two vaccines. Our results suggest that: third doses are necessary due to the emergence of different SARS-CoV-2 variants and postvaccination antibody testing continues be essential in determining possible standardization of SARS-CoV-2 vaccines regimens.
Osteoma is a benign osteogenic tumor arising from the proliferation of cancellous or compact bone. In the facial bones, both central and peripheral osteomas have been described in the literature. Peripheral type of osteoma is the most common variant in the mandible, which occurs on the cortical bone surface. We present a case of a fourteen year old boy who had swelling on right and left parasymphyseal region. Radiographs revealed radiopacity having onion-peel appearance and histopathology gave the final diagnosis of osteoma. Periosteal reaction giving rise to onion peel appearance on the radiograph has been reported in Ewing sarcoma, Garre’s osteomyelitis and infantile cortical hyperostosis in the literature but our case shows that similar appearance can be there in osteoma as well.
Daniel Miller, Karim Makhoul, Allison Foster and Asma Ul Hosna*
Published on: 24th November, 2022
Chronic thromboembolic pulmonary hypertension is a notoriously underdiagnosed cause of severe pulmonary hypertension. It is a form of precapillary pulmonary hypertension (PH) that results from intraluminal thrombus organization and fibrous formation which ultimately results in the complete obliteration of pulmonary arteries, resulting in increased pulmonary vascular resistance which leads to the development of pulmonary hypertension and as a result right heart failure. The mechanism involves the narrowing of the pulmonary artery which increases blood pressure within the lungs and impairs blood flow which increases the workload of the right side of the heart ultimately causing right heart failure. Pulmonary hypertension can also cause arrhythmias, blood clots, and bleeding in the lungs. Even though CTEPH is a deadly condition, among all forms of pulmonary hypertension, CTEPH is the only curable form. Echocardiography is the initial assessment tool for suspected PH. A right heart catheterization may be performed to confirm the presence of pulmonary hypertension. Confirmation of CTEPH requires a V/Q scan. Although ventilation/perfusion scintigraphy has a major role in the evaluation of patients with suspected CTEPH, nowadays CTA chest is being used widely as it produces much better-quality images compared to V/Q scan. Without treatment, the prognosis is very poor. Out of three treatment modalities such as; pulmonary endarterectomy (PEA) surgery, balloon pulmonary angioplasty (BPA), and medical therapy, surgery is the gold standard. The physician must be familiar with the disease entity, early diagnosis, and appropriate treatment to improve survival. Here we present a literature review on this topic.
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