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Showing papers by "Bethesda Hospital published in 2019"


Journal ArticleDOI
01 Jan 2019
TL;DR: The rate of IVT in patients with acute ischemic stroke in Germany continues to rise and has reached 14.9% nationwide and the increase of MT is even more pronounced and was triggered by the evidence after publication of the MT randomized trials.
Abstract: Mechanical thrombectomy (MT) is a new evidence-based treatment option for large vessel occlusion in the anterior brain circulation. Using comprehensive administrative data from Germany, we analysed the nationwide development of intravenous thrombolysis (IVT) and MT in Germany between 2010 and 2016. We considered all documented cases (n = 1,515,634) with a main diagnosis of the ICD-10-GM code I63 (ischemic stroke) and identified specific stroke recanalization therapy by using the corresponding Operating and Procedure Key for systemic thrombolysis and mechanical thrombectomy out of the DRG statistics. Regional analyses are based on data from the 413 German administrative districts and cities and the obligatory quality reports of all hospitals. We distinguished between rates of MT related to place of residence of patients and place of treatment. Coded ischemic strokes increased by 10.2% from 2010 (n = 206.688) to 2016 (n = 227.687). The rate of IVT increased from 8.9% in 2010 to 14.9% in 2016 and the rate of MT increased from 0.8% in 2010 to 4.7% in 2016 with a strong increase in 2015 and 2016. There was a high regional variability of MT according to place of residence of patients between 0 and 11.2% in 2016 with significant lower treatment rates in rural compared to urban areas (3.8 vs 5.4%). Mean age of patients treated with MT increased from 67.8 years in 2010 to 73.3 years in 2016 and almost reached the mean age of IVT treated patients (74.4 years). The number of hospitals coding MT increased from 91 to 193 from 2010 to 2016, but 80% of all MT procedures were performed in neurointerventional centers with ≥50 procedures/year in 2016. The rate of IVT in patients with acute ischemic stroke in Germany continues to rise and has reached 14.9% nationwide. The increase of MT is even more pronounced and was triggered by the evidence after publication of the MT randomized trials. There is still a high regional variability with significant lower MT rates in rural areas.

37 citations


Journal ArticleDOI
TL;DR: This survey revealed variation in beliefs and practices surrounding rehabilitation and RTS evaluation in Australian therapists.

29 citations


Journal ArticleDOI
TL;DR: A small subset of ILBCs harbors potentially actionable ERBB2 mutations, and no association with pleomorphic histology was found in ER BB2‐mutatedILBCs.
Abstract: HER2-positive breast cancer is defined by amplification or overexpression of the HER2/ERBB2 oncogene and accounts for about 15% of breast cancer cases. Somatic mutation of ERBB2 is an alternative mechanism, by which activation of HER2 signaling can occur. ERBB2 mutation has been associated with invasive lobular breast cancer (ILBC). This study investigates the frequency and phenotype of ILBC harboring mutated ERBB2. The ERBB2 mutation status was determined by next generation sequencing and/or pyrosequencing in n = 106 ILBCs, including n = 86 primary or locally recurrent tumors and n = 20 metastases from visceral organs, soft tissue, or skin. Immunohistochemical characteristics were determined using tissue microarrays. This series was enriched for ILBCs with pleomorphic histology and/or high-risk expression profiles (Oncotype DX, recurrence score RS > 25). Nearly all specimens were E-cadherin-negative (99%), estrogen receptor (ER)-positive (92%), and lacked ERBB2 overexpression (96%). ERBB2 mutations (p.V777L, p.L755S, p.S310F) were identified in 5/106 (5%) cases. ERBB2-mutated cases included 2/86 (2%) primary tumors and 3/20 (15%) metastases (P = 0.045). ERBB2-mutated cases were associated with loss of ER (2/7, 29%, P = 0.035) and histological grade 3 (4/34, 12%, P = 0.023), but not with solid growth (3/31, 10%, P = 0.148) or pleomorphic histology (2/27, 7%, P = 0.599). No ERBB2 mutation was detected in ILBCs with RS > 25 (0/22, 0%). In 10 patients with multiple matched specimens (n = 25), the ERBB2 mutational status was always concordant. In summary, a small subset of ILBCs harbors potentially actionable ERBB2 mutations. In ERBB2-mutated ILBCs, no association with pleomorphic histology was found.

21 citations


Journal ArticleDOI
TL;DR: Exposure to stressful life events (SLEs) in early, but not late gestation, are associated with reduced adult male reproductive function, consistent with the hypothesis that events during early prenatal life programme adultmale reproductive function is affected.
Abstract: Study question Is exposure to gestational stress in the critical time window for the normal differentiation and growth of male reproductive tissue associated with male reproductive function in offspring in later life? Summary answer Exposure to stressful life events (SLEs) in early, but not late gestation, are associated with reduced adult male reproductive function, consistent with the hypothesis that events during early prenatal life programme adult male reproductive function. What is already known Animal studies suggest that gestational stress may impact on the reproductive function of male offspring, but human evidence is sparse. Study design, size, duration Using a prospective longitudinal cohort, we examined the association between number and type of maternal stressors during pregnancy in both early and late gestation and reproductive function in 643 male Generation 2 (offspring) at age 20 years. Mothers and their male Generation 2 (offspring) from The Raine Study participated. Mothers prospectively reported SLEs during pregnancy recorded at gestational weeks 18 and 34 using a standardized 10-point questionnaire. Participants/materials, setting, methods The 643 male Generation 2 (offspring) underwent testicular ultrasound examination and semen analysis and provided serum for reproductive hormone analysis. Multivariate linear regression analysis was used to examine associations. Main results and role of chance Of 643 recruited males, 407 (63%) were exposed to at least one SLE in early gestation. Fewer SLEs were reported in late gestation (n = 343, 53%). Maternal SLE exposure in early gestation was negatively associated with total sperm count (β = -0.31, 95% CI -0.58; -0.03), number of progressive motile sperm (β = -0.15, 95% CI -0.31; 0.00) and morning serum testosterone concentration (β = -0.04, 95% CI -0.09; -0.00). No similar effects of maternal SLE exposure in late pregnancy were detected. The large sample size and an objective detailed direct assessment of adult male reproductive function with strict external quality control for sperm quality, as well as detailed prospectively collected information on prenatal SLEs in two distinct time windows of pregnancy reported by the women in early and late gestation along with other risk factors, imply minimal possibility of recall, information bias and selection bias. When assessing our results, we adjusted for a priori chosen confounders, but residual confounding or confounding by factors unbeknown to us cannot be ruled out. Limitations, reasons for caution It is not possible to measure how SLEs impacted differently on the mother's experience or perception of stress. Resilience (coping) gradients may alter cortisol levels and thus modify the associations we observed and the mothers' own perception of stress severity may have provided a more precise estimate of her exposure. Wider implications of the findings Our findings suggest that exposure to SLEs in early, but not late gestation, are associated with reduced adult male reproductive function. Improved support for women with exposure to SLEs during pregnancy, particularly during the first trimester, may improve the reproductive health of their male offspring in later life. Intervention studies of improved pregnancy support could provide more insight into this association and more information is needed about the potential specific epigenetic mechanisms underlying this association. Study funding/competing interest(s) The male fertility sub-study was funded by NHMRC Grant 634 457. The core management of the Raine Study is funded by University of Western Australia, Curtin University, Telethon Kids Institute, Women and Infants Research Foundation, Edith Cowan University, Murdoch University, The University of Notre Dame Australia and Raine Medical Research foundation. Dr Brauner's salary was supported by Laege Sofus Carl Emil Friis og Hustru Olga Doris Friis foundation in Denmark. All authors declare no competing interests. Trial registration number N/A.

20 citations


Journal ArticleDOI
TL;DR: NTT for GD is not superior to TT regarding transient postoperative hypoparathyroidism, and the rate of inadvertently removed parathyroid glands was significantly higher after NTT than after TT.
Abstract: Background:Previous data suggest that the incidence of hypoparathyroidism after surgery for Graves disease (GD) is lower after subtotal thyroidectomy compared to total thyroidectomy (TT). The present study evaluated the incidence of postoperative hypoparathyroidism after near-total (NTT) versus TT i

12 citations


Journal ArticleDOI
TL;DR: It is concluded that Gla‐100 was effective at reducing FBG and HbA1c, independent of the titration algorithm, but observed that algorithms were inconsistently applied in clinical practice.
Abstract: For patients with type 2 diabetes mellitus (T2DM) and inadequate glycaemic control, addition of basal insulin is recommended, but titration and optimization of basal insulin therapy in primary care is not well understood We conducted an observational trial in 2470 patients with T2DM who initiated insulin glargine 100 U/L (Gla-100) on top of oral antidiabetic drugs Physicians were free to choose either a "Davies," "Fritsche" or "individual" titration algorithm We found that fasting blood glucose (FBG) and glycated haemoglobin (HbA1c) levels were effectively reduced by Gla-100; 659% of patients achieved the primary endpoint (FBG ≤61 mmol/L (110 mg/dL) or an individual HbA1c target) There were no significant differences in efficacy and safety between the algorithms used The mean FBG decreased by 32 mmol/L (59 mg/dL) over 12 months, while the mean HbA1c decreased by 153 mmol/mol (14%)% From a starting dose of 117 U/d, the Gla-100 dosage was 228 U/d at 12 months, with similar values in each group Rates of hypoglycaemia were low and did not differ by titration algorithm We conclude that Gla-100 was effective at reducing FBG and HbA1c, independent of the titration algorithm, but observed that algorithms were inconsistently applied in clinical practice

12 citations


Journal ArticleDOI
TL;DR: In this paper, the concept of mentalization has become increasingly widespread in the psychotherapy discourse, and three important questions in relation to music therapy and music therapy have been investigated in the context of music therapy.
Abstract: Introduction: The concept of mentalization has become increasingly widespread in the psychotherapy discourse. This article investigates three important questions in relation to music therapy and me...

8 citations


Journal ArticleDOI
TL;DR: A prospective, multi-center, interventional, two-arm, open-label, controlled (neo)adjuvant, non-blinded, randomized phase III trial of ADAPTcycle in patients with Huntington's disease.
Abstract: TPS596Background: WSG (West German Study Group)-ADAPTcycle is a prospective, multi-center, interventional, two-arm, open-label, controlled (neo)adjuvant, non-blinded, randomized phase III trial (Eu...

7 citations


Journal ArticleDOI
TL;DR: Recurrent implantation failure (RIF) is repeated unsuccessful embryo transfers (ETs) that occur after at least two attempts at implantation.
Abstract: Background Recurrent implantation failure (RIF) is repeated unsuccessful embryo transfers (ETs). Aims To identify predictive embryonic markers of implantation in RIF, following pre-implantation genetic screening (PGS) of cleavage stage embryos, after accounting for male and female factors. Materials and methods Retrospective analysis of RIF patients undergoing PGS after correction of modifiable causes. Results Eighty-four patients underwent 140 in vitro ferilisation cycles. Forty-one cycles were excluded: 12 (no embryo for transfer), four (double ETs) and 25 (no biopsy). Sixty-three patients underwent 99 single euploid ETs (48 fresh, 51 frozen) resulting in 11 biochemical pregnancies, 36 clinical pregnancies (CP), and six miscarriages and 30 live births (LB). Frozen ET was more successful than fresh; respective live birth rate (LBR) and clinical pregnancy rate (CPR), 39.2% versus 20.8%, (P = 0.02), 45.1% versus 27.1% (P = 0.04). LBR and CPR were lower when 5-6 blastomeres were present at embryo biopsy, compared to embryos with ≥7 blastomeres: 15.4% versus 32.6% (P = 0.185) and 15.4% versus 39.5% (P = 0.074) respectively. Serum β human chorionic gonadotropin (βhCG) concentration was greater when a more developed embryo was biopsied (r = 0.448, P = 0.017 and r = 0.476, P = 0.118, fresh and frozen transfers, respectively). Embryo morphokinetic analysis demonstrated faster development to blastocyst stage when more cells were present at biopsy: mean 103.3, 102.2 and 96.0 h for biopsy at the 5-6, 7-8 or ≥9 cell stage respectively (P = 0.040 for difference between 7-8 cells vs ≥9). Conclusions After cleavage stage biopsy, frozen ET was more successful than fresh ET. Chance of conception and serum βhCG concentration correlated with number of cells present at time of biopsy.

6 citations


Journal ArticleDOI
TL;DR: Patients with IT pump therapy presenting new neurological findings need prompt imaging of the spinal axis to rule out a catheter-tip granuloma, and early surgical decompression is important.
Abstract: Background A serious complication of intrathecal (IT) infusion therapy for pain management is catheter-tip-associated granuloma. Catheter-tip granulomas can lead to permanent severe neurological sequelae if not promptly detected. Case description We report a patient with a recurrence of a catheter-tip granuloma causing a high-grade paresis of the lower extremities and we review briefly the literature. Conclusion Patients with IT pump therapy presenting new neurological findings need prompt imaging of the spinal axis to rule out a catheter-tip granuloma. In case of catheter-tip granuloma, early surgical decompression is important.

5 citations


Journal ArticleDOI
TL;DR: Controversial speculation suggestions that dietary intake may affect semen quality and testicular function, however, there are limited comprehensive studies observing dietary patterns.
Abstract: Background: Controversial speculation suggestions that dietary intake may affect semen quality and testicular function, however, there are limited comprehensive studies observing dietary patterns. Objective: To study associations between major dietary patterns and markers of testicular function in adulthood. Material and Methods: Observational cross-sectional study of two hundred and ninety men with an average age of 20 years, from the Western Australian Pregnancy Cohort (Raine) Study. Usual dietary intake assessed using a semi-quantitative food frequency questionnaire at 20 years of age. Two dietary patterns previously identified using exploratory factor analysis ("Healthy" or "Western") and participants received z-scores for each dietary pattern. Primary endpoints were testicular volume, total sperm per ejaculate, morning serum testosterone concentration. Secondary endpoints were semen sample parameters, inhibin B and sex steroids (DHT: 3α-diol, 3β-diol; LH; FSH; DHEA; estradiol; estrone). Result(s): Participants were on average 20.0 ± 0.4 years old, had a median of 2 days sexual abstinence and a body mass index of 24.1 ± 3.9 kg/m 2 , 13% were smokers, 52% were 'moderate' alcohol drinkers, 23% frequently used recreational drugs and 68% reported 'high' physical activity levels. Sperm concentration and DHT 3α-diol were negatively associated with a greater z-score for the "Western" dietary pattern ( p = 0.007 and; p = 0.044, respectively), and serum estradiol concentration was positively associated with a "Western" dietary pattern ( p = 0.007) after adjustment for BMI, varicocele, cryptorchidism and sexual abstinence. Discussion: Despite associations between greater intake of the "Western" dietary pattern and a decreased male reproductive health markers, our lack of consistent associations of either a "Healthy" or a "Western" dietary pattern, limit clinical or biological significance in isolation. Conclusions: A potential negative association of a "Western" dietary pattern with male reproductive health was detected and should be studied further in population-based studies.

Journal ArticleDOI
TL;DR: An innovative technique is presented for salvage of a failed total ankle replacement resulting from talar subsidence with the use of a custom 3-dimensional printed articulating talar component with a titanium truss cage, introducing a better alternative to an ankle arthrodesis with which ankle joint function and range of motion may be preserved.
Abstract: An innovative technique is presented for salvage of a failed total ankle replacement resulting from talar subsidence with the use of a custom 3-dimensional printed articulating talar component with a titanium truss cage. This introduces a better alternative to an ankle arthrodesis with which ankle joint function and range of motion may be preserved.

Journal ArticleDOI
TL;DR: HbA1c was the clinically most significant baseline characteristic predictive of response to BOT, and may suggest an advantage of IGlar‐100 initiation prior to excessive hyperglycaemia escalation.
Abstract: The aim of this study was to identify predictors of long-term response to the initiation of basal-supported oral therapy (BOT) with insulin glargine (IGlar-100). Patients from the observational TOP registry were grouped based on those who had achieved (responders) and those who had not achieved (non-responders) their HBA1c target and/or FBG ≤110 mg/dL 12 months after IGlar-100 initiation. Independent predictors of treatment response were identified by regression analysis. Data for 2444 patients were analysed (responders, n = 1610; non-responders, n = 834). Although the IGlar-100 dose increase over 12 months was larger for non-responders (+12.83 vs +9.46 U/d; P < 0.0001), the corresponding decrease in HbA1c was smaller (-0.88% vs -1.57%). Independent predictors of response included lower BMI (OR, 0.97; 95% CI, 0.95-1.00), lower FBG (OR, 0.98; 95% CI, 0.97-0.98) and HbA1c values at baseline (OR, 0.24; 95% CI, 0.18-0.31), a less ambitious HbA1c target (OR, 5.07; 95% CI, 3.37-7.63) and bedtime administration of IGlar-100 (OR, 1.55; 95% CI, 1.12-2.14). In conclusion, HbA1c was the clinically most significant baseline characteristic predictive of response to BOT. This may suggest an advantage of IGlar-100 initiation prior to excessive hyperglycaemia escalation.

Journal ArticleDOI
TL;DR: The adjuvant use of dd chemotherapy led to a statistically significant improvement of DFS after a follow-up of 12.3 years, and the tumour burden was a significant predictor for DFS and OS.
Abstract: Purpose Although dose-dense (dd) chemotherapy plays a fundamental role in the treatment of breast cancer (BC), a variety of trials have presented divergent survival results Here, we present data of patients with more than 3 positive axillary lymph nodes (+aLN) receiving dd chemotherapy after a median follow-up period of 123 years Methods In the years 1996-2000, 231 patients with invasive BC, ≥pN2a and no evidence of distant metastases were recruited to receive treatment A, ie dd 3 × epirubicin (E, 90 mg/m2) + paclitaxel (P, 175 mg/m2) every 2 weeks (q2w) followed by 3 × cyclophosphamide (C)/methotrexate/5-fluorouracil (CMF, 600/40/600 mg/m2, q2w), or treatment B, ie 4 × E + C (C, 600 mg/m2) q3w followed by 3 × CMF q3w Results 113 patients in arm A and 113 patients in arm B were analysed after an updated median follow-up of 123 years The median age was 55 years, with a median number of 6 +aLN, 504% had a T2 and 792% hormone receptor-positive BC The disease-free survival (DFS) rate was 531% in arm A and 425% in arm B (adjusted p = 0027) The overall survival (OS) rate was 549% in arm A and 487% in arm B (adjusted p = 0058) In the multivariable analysis, the tumour burden was a significant predictor for DFS and OS Conclusion The adjuvant use of dd chemotherapy led to a statistically significant improvement of DFS after a follow-up of 123 years

Journal ArticleDOI
06 Mar 2019-Cureus
TL;DR: A case of a 56-year-old woman who demonstrated the classic features of type one GNET with mucosal and submucosal involvement in the setting of primary atrophic gastritis, secondary hypergastrinemia, and underlying pernicious anemia is presented.
Abstract: Gastric neuroendocrine tumors (GNET) are rare gastric neoplasms accounting for <1% of all gastric neoplasms. The World Health Organization (WHO) categorized these neoplasms as types 1-3 to help predict malignant potential and long-term survival and guide management. Improved outcomes have been shown with endoscopic resections, but further studies are needed to confirm the best approach. We present a case of a 56-year-old woman who demonstrated the classic features of type one GNET with mucosal and submucosal involvement in the setting of primary atrophic gastritis, secondary hypergastrinemia, and underlying pernicious anemia. In general, standardizing treatment has been difficult due to a variable presentation.

Journal ArticleDOI
TL;DR: Prenatal SLE exposure was not associated with a statistically significant increase in the risk of cryptorchidism in male offspring, and the first-time report on the possible relationships between exposure to early and late pregnancy SLEs and risk of cryptography in a birth cohort is reported.
Abstract: Cryptorchidism, registered at birth or later, is the most common birth defect in males in western countries, estimated to affect around 2-3% of newborn boys, declining to around 2% at 3 months. We have previously described a potential association between stressful life events (SLEs) in pregnancy and reduced semen quality and testosterone levels in adult offspring. Both outcomes are believed to share a common etiology with cryptorchidism thus increased risk of cryptorchidism in boys exposed to prenatal SLEs may be plausible. The risk of cryptorchidism associated with prenatal SLE amongst 1,273 male Generation 2 offspring was estimated using the Western Australian Pregnancy (Raine) Study. SLEs are discrete experiences that disrupt an individual's usual activities causing a life change and readjustment, such as death of a relative or friend, divorce, illness or job loss. Mothers prospectively reported SLEs, during pregnancy at gestational weeks (GW) 18 and 34 using a standardized 10-point questionnaire. A boy was diagnosed as cryptorchid if one or both testes was non-palpable in the scrotum and not able to be manipulated into the scrotum. Twenty-four (2%) cryptorchid boys were identified. Mean (standard deviation) of SLE exposures in GW34 was 1.1 (1.2) for non-cryptorchid boys and slightly higher 1.5 (1.8) for cryptorchid boys, similar differences were observed in GW18. Adjusted odds ratio [OR] and 95% confidence intervals (CI) for risk of cryptorchidism in early (18-weeks) and late gestation (34-weeks) according to prenatal SLE exposures were: 1.06 (95% CI: 0.77-1.45) and 1.18 (95% CI: 0.84-1.67), respectively. This is the first-time report on the possible relationships between exposure to early and late pregnancy SLEs and risk of cryptorchidism in a birth cohort. Prenatal SLE exposure was not associated with a statistically significant increase in the risk of cryptorchidism in male offspring. A small case population limits the statistical power of the study and future larger studies are required to evaluate this potential association.

Journal ArticleDOI
TL;DR: This study demonstrates the safety of BT-11 in the adolescent by showing no apparent adverse reactions related to it.

Journal ArticleDOI
TL;DR: A novel surgical technique is highlighted that may be used to successfully address severe hallux abductovalgus deformity with dislocation and contracture at the first metatarsophalangeal joint while minimizing the likelihood of complications.
Abstract: Severe hallux abductovalgus deformity with dislocation and contracture at the first metatarsophalangeal joint is difficult to manage, especially in the presence of concomitant, long-standing rheuma...


Journal ArticleDOI
TL;DR: The allodynia at the unaffected site suggests the presence of central sensitisation of pain processing in patients with leg ulcers, which might have contributed to ulcer development via (partial) loss of protective function.
Abstract: Objective: Pain is a common and disabling symptom in patients with leg ulcers. Clinical quantification of pain mostly depends on subjective pain reports, which do not reveal underlying mechanisms. ...

Journal ArticleDOI
TL;DR: It is indicated that the intravenous administration of autologous AdMSC can be a safe alternative for DBA treatment and the RBC number, hemoglobin level, and hematocrit were improved 9 months after the systemic administration of AdMSCs from baseline.
Abstract: Diamond-Blackfan anemia (DBA) is a rare congenital erythropoietic disorder characterized by erythroblastopenia. Conventional treatments of DBA are the administrations of corticosteroids and blood transfusions for mitigation of anemia, and bone marrow transplantation. However, there are hurdles to overcome for long-term use and the conventional treatment. Mesenchymal stem cells (MSCs) have been noted as a novel alternative cell therapy in various diseases, and adipose tissue-derived MSCs (AdMSCs) are known for their versatile efficacies and feasibility. Here, we report the potential efficacies and the safety of intravenous administration of the autologous AdMSC in a patient with DBA for the first time. The isolation and characterization of autologous AdMSCs from a girl aged 11 years, 10 months with DBA were carried out due to the mutation of ribosomal protein s24 (RPS24). AdMSCs, diluted to 1 x 10 8 cells in 100 ml of saline, were infused intravenously for 1 hour. Intravenous administration of AdMSCs was carried out 5 times in 2-week intervals, and the patient was checked using various assessments (vital signs, physical examination, laboratory tests, adverse events, etc) at every visit. After 3, 6 and 9 months from the first administration of AdMSCs, red blood cell (RBC) count, hemoglobin value, and hematocrit were assessed for the efficacy. There were no side effects or adverse events observed during the treatment. Although showing subnormal values, the RBC number, hemoglobin level, and hematocrit were improved 9 months after the systemic administration of AdMSCs from baseline; the RBC count (x10 6 /μl), hemoglobin level (g/dl) and hematocrit level (%) were increased from 1.58 to 2.38, 5.6 to 8.3, and 16.9 to 26.1, respectively. The present case reported the first AdMSC administration for DBA patient and indicates it is possible that the intravenous administration of autologous AdMSC can be a safe alternative for DBA treatment.

Book ChapterDOI
01 Jan 2019
TL;DR: The complement system has three activation pathways: the classical pathway, the mannose pathway, and the alternate pathway.
Abstract: The complement system has three activation pathways: the classical pathway, the mannose pathway, and the alternate pathway

Journal ArticleDOI
TL;DR: OTI showed the potential to be a supplementary imaging modality for the quantification of synovial inflammation in PIP and MCP joints of RA patients and showed positive results in 11.4% of clinically asymptomatic joints.
Abstract: Optical tomographic imaging (OTI) was reported to be a novel technique for the early diagnosis and disease activity assessment of rheumatoid arthritis (RA). This study aimed to evaluate the clinical utility of OTI for the detection of hand synovitis of RA patients. Manu-scan was used to perform imaging targeting the proximal interphalangeal (PIP) and metacarpophalangeal (MCP) joints in 12 RA patients and three controls. The enrolled RA patients also underwent magnetic resonance imaging (MRI) and bone scintigraphy (BS) to provide reference images. Of the 181 joints feasible for OTI analysis, 140 joints (111 in RA patients and 29 in controls, 77.3%) in which the difference of the OTI indices in the two measurements was within 20% were evaluated. The OTI indices in RA joints were significantly lower than those in control joints (p < 0.001). Overall, the OTI indices in RA joints decreased as the synovitis grades on MRI or BS increased. Moreover, OTI was able to discriminate between RA and control joints (AUC = 0.815, 95% CI 0.739–0.891), even if RA joints were normal on physical examination (AUC = 0.714, 95% CI 0.594–0.834). OTI was in good agreement (kappa = 0.60) with MRI for evaluating synovitis in RA patients and showed positive results in 11.4% of clinically asymptomatic joints. OTI in this study showed the potential to be a supplementary imaging modality for the quantification of synovial inflammation in PIP and MCP joints of RA patients. Further large-scale trials are needed to confirm these findings.

Journal ArticleDOI
Gernot Rott1
TL;DR: The only way to eliminate the risk of opening the guiding cannula to the atmosphere in coaxial-biopsy of lung-lesions is the use of a hemostatic valve.
Abstract: 1. The case described is a good example for the fact that the technique of using a ‘‘water-seal’’ (or ‘‘saline-drop’’, or similarly ‘‘finger or cap on the needle’’) to prevent air embolism during coaxial lung biopsy does not work. The statement ‘‘Air was noticed to come out of the coaxial needle’’ clearly shows that the coaxial needle had been opened to the atmosphere—if air can get out, it also can get in. We are convinced that the only way to eliminate the risk of opening the guiding cannula to the atmosphere in coaxial-biopsy of lung-lesions is the use of a hemostatic valve. The so-called ‘‘hemostatic-valvecoaxial-biopsy-technique’’ has been described in detail in our publication from 2014 [2]. 2. There is obviously a fundamental misunderstanding regarding the well-founded recommendation of Freund et al. to ‘‘locate the lesion below the level of the left atrium’’ to prevent air embolism [3]. What is relevant in this respect alone is the position of the lesion in relation to the left atrium during biopsy (!) and not in supine position during the diagnostic computed tomography scan. The figure of the biopsy clearly shows the lesion high above the level of the left atrium, as the patient position is ‘‘contralateral-dependent’’ instead of the recommended ‘‘ipsilateral-dependent’’ [2, 4, 5].

Journal ArticleDOI
Gernot Rott1
TL;DR: A standardized nomenclature is critical for scientific communication and patient management, and utilizing the ISSVA approach for classification of vascular lesions is strongly recommended, not only for skin or soft tissue, but also for bone and viscera.
Abstract: Dear Editor, I read with interest the article by Akhlaghpoor et al [1] entitled ‘‘Transarterial Bleomycin–Lipiodol Embolization (B/LE) for Symptomatic Giant Hepatic Hemangioma.’’ However, I would like to comment on the term ‘‘hemangioma,’’ as the treated lesions obviously are not hemangiomas. The word ‘‘hemangioma’’ has been used for decades and unfortunately still is widely used in everyday practice to describe several lesions, which are nowadays known to be distinct pathological entities [2]. Suitable terms, that should be applied in this regard, are defined by the International Society for the Study of Vascular Anomalies (ISSVA) and summarized in its classification for vascular anomalies, recently updated in May 2018. Experts of the ISSVA and others assume that liver or hepatic ‘‘hemangioma’’ in adult is in fact not a hemangioma at all, but rather a slow-flow vascular malformation, more precisely a venous malformation [2–5]. These lesions are histopathologically composed of malformed vessels, are glucose transporter 1 (GLUT 1) negative and do not undergo mitosis, and thus are vascular malformations [6]. A standardized nomenclature is critical for scientific communication and patient management, and utilizing the ISSVA approach for classification of vascular lesions is strongly recommended, not only for skin or soft tissue, but also for bone and viscera. It is long overdue to put an end to the general incorrect use of the term ‘‘hemangioma,’’ also and in particular within the radiological community.

Journal ArticleDOI
Elien Nijland1
TL;DR: The very rare Hirayama disease is discussed, including the impact on the patient’s functioning, and the unique way to solve an orthesis problem is described, by observing patient's performance meticulously.
Abstract: The aim of this case report is twofold: the very rare Hirayama disease is discussed, including the impact on the patient’s functioning. The unique way to solve an orthesis problem is described, by ...

Journal ArticleDOI
17 Aug 2019-Cureus
TL;DR: A rare case of an 80-year-old male with a history of GCA who was found to have developed HAA following an episode of acute pancreatitis that was repaired surgically with an open technique is presented.
Abstract: Visceral artery aneurysms are rare with an incidence of 0.1%-0.2%. Of these, 20% are hepatic artery aneurysms (HAAs). Despite the potential of remaining asymptomatic for long periods of time, the risk of rupture for HAAs is 20%-80%. Treatment includes operative management with open or endovascular techniques. HAA in the setting of pancreatitis has been reported in two prior cases outside of the United States. However, there have been no cases describing the association of HAA and giant cell arteritis (GCA). We present a rare case of an 80-year-old male with a history of GCA who was found to have developed HAA following an episode of acute pancreatitis that was repaired surgically with an open technique. To our knowledge, the association between HAA with acute pancreatitis and GCA has not been reported before.