Patients with bone metastases from renal cell carcinoma often are not surgical candidates and have a poor prognosis. There are limited data on the use of cryoablation as a locoregional therapy for ...bone metastases. Our objective was to assess the local tumor-control rate following cryoablation of bone metastases in the setting of renal cell carcinoma.
We retrospectively reviewed the medical records of patients with metastatic renal cell carcinoma who underwent cryoablation for bone metastases between 2007 and 2014. We excluded patients if the intent of treatment was for pain palliation only, if cryoablation was performed without an attempt for complete tumor control (cytoreduction), or if the patient had no further follow-up beyond the cryoablation procedure. We recorded patient demographics, procedural variables, and complications. Cross-sectional imaging and clinical follow-up were reviewed to determine disease recurrence. The median overall survival and recurrence-free survival were determined using the Kaplan-Meier method.
Forty patients (30 male and 10 female) with 50 bone metastases were included for analysis. The mean patient age was 62 years (range, 47 to 82 years). The median follow-up was 35 months (95% confidence interval CI, 22.7 to 74.4 months). Twenty-five (62.5%) of the 40 patients had oligometastatic disease, defined as ≤5 metastases at the time of ablation. The mean tumor size was 3.4 ± 1.5 cm. Metastases in the pelvic region represented 68% of the treated tumors (34 of 50). The overall local tumor-control rate per lesion was 82% (41 of 50). Patients with oligometastatic disease experienced better local tumor control (96% 24 of 25) compared with patients who had >5 metastases (53.3% 8 of 15) (p = 0.001). The local tumor-control rate was better for lesions for which a larger mean difference between maximum ice-ball diameter and maximum lesion diameter was achieved (2.2 ± 0.9 cm for those without recurrence versus 1.35 ± 1.2 cm for those with recurrence; p = 0.005). There were 3 grade-3 complications and 1 grade-4 complication.
Cryoablation can be effective for achieving local oncologic control in bone metastases from renal cell carcinoma and may represent a valuable alternative to surgical metastasectomy in select patients.
Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.
The purposes of this article are to illustrate the CT appearance of gastrointestinal vasoocclusive crisis in patients with sickle cell disease (SCD), highlight potential complications, and review ...other conditions that may have similar findings.
The gastrointestinal vasoocclusive crisis in SCD is rare but can result in potentially life-threatening ischemia and death. Knowledge of the spectrum of CT features of the gastrointestinal vasoocclusive crisis is important in making the diagnosis and potentially preventing complications.
Purpose
The purpose of this study was to determine the incidence, specific imaging features, and outcome of gastrointestinal vaso-occlusive ischemia (GVOI) in sickle cell patients undergoing CT for ...acute abdominal pain.
Methods
This HIPAA-compliant, IRB-approved retrospective study evaluated sickle cell patients with an abdominal pain crisis and acute gastrointestinal abnormalities on CT from 1/2006 to 1/2014. CT findings were divided into those compatible and incompatible with bowel ischemia or clinical diagnosis of GVOI. Two abdominal radiologists (1, 13 years’ experience) reviewed the CTs for specific imaging features of ischemia. Clinical laboratory values (lactate, WBC) and outcome were recorded. Descriptive statistics and Wilcoxon–Mann–Whitney two-sample rank-sum test were performed.
Results
Of 217 CTs, 33 had acute gastrointestinal abnormalities: 75% (25/33) consistent with ischemia and clinical GVOI. Complications of ischemia occurred in 16% (4/25): ileus (50%), perforation (25%), and pneumatosis (25%). In uncomplicated cases, all had bowel wall thickening: segmental 52% (11/21) or diffuse 48% (10/21). The colon was commonly involved (76%, 16/21), particularly the ascending (57%, 12/21). Most abnormalities (52%, 11/21) were in the superior mesenteric artery distribution. Average lactate (4.3 ± 4.0 mmol/L,
p
= 0.02) and WBC count (20.1 ± 10.4, ×1000 cells/μL,
p
= 0.01) were significantly higher in GVOI. Overall mortality in patients with GVOI was 17% (3/18).
Conclusion
GVOI is an important feature of the acute abdominal crisis in patients with sickle cell disease and can be seen in up to 75% of patients with abnormal bowel findings on CT. The diagnosis should be strongly considered in sickle cell patients with CT findings of diffuse or segmental bowel wall thickening, particularly involving the colon.
To describe unique ocular features in a child with Joubert syndrome type 6.
A 4-year-old male patient presented with right microphthalmia and non-dilating pupil and left primary position nystagmus. ...Brain MRI revealed a “molar tooth sign” of the midbrain and a “batwing sign” of the fourth ventricle along with large retroorbital cysts bilaterally. The diagnosis of autosomal recessive Joubert syndrome type 6 due to homozygous pathogenic variant c.725A > G p. (Asn242Ser) in TMEM67 gene was confirmed by whole exome sequencing. Left eye had nystagmus and the left optic nerve and retina showed epipapillary and subretinal fibrosis, respectively. Scleral buckle was performed for left non-rhegmatogenous retinal detachment which then improved and has been stable.
We present a rare case of JS with some unique ophthalmic features which expand clinical knowledge on this complex systemic and ocular entity.
•Joubert syndrome is a ciliopathy diagnosed via genetic testing or pathognomonic brain MRI findings.•It can present numerous ocular features including oculomotor apraxia and retinal pathology mostly pigmentary retinopathy.•Epipapillary and subretinal fibrosis can be present in Joubert syndrome.
After conducting a literature review on March 20, 2024 utilizing PubMed, Google Scholar and Web of Science search engines using the key words Joubert syndrome (review), eye, retina, optic nerve, fibrosis, we did not find any prior reports of epipapillary and/or subretinal fibrosis reported in any type of Joubert syndrome spectrum.
Abstract
Background
Governments internationally have invested hugely in the implementation and scale-up of school-based physical activity interventions, but have little evidence of how to best ...sustain these interventions once active implementation support ceases. This study will assess the effectiveness of a multi-strategy sustainability intervention on classroom teachers’ sustainment of energisers (short 3–5 min physical activity breaks during class-time) scheduled across the school day from baseline to 12 and 24-month follow-up.
Methods
A cluster randomised controlled trial will be conducted in 50 primary schools within the Hunter New England, Illawarra Shoalhaven, Murrumbidgee and Northern New South Wales (NSW) Local Health Districts of NSW Australia. Schools will be randomly allocated to receive either usual support or the multi-strategy sustainability intervention that includes: centralised technical assistance from a trained project officer; formal commitment and mandated change obtained from school principals; training in-school champions; reminders for teachers; educational materials provided to teachers; capturing and sharing local knowledge; and engagement of parents, carers and the wider school community. The primary trial outcome will be measured via a teacher logbook to determine the between-group difference in the change in mean minutes of energisers scheduled across the school day at 12 and 24-month follow-up compared to baseline. Analyses will be performed using an intention to treat framework. Linear mixed models will be used to assess intervention effects on the primary outcome at both follow-up periods.
Discussion
This study will be one of the first randomised controlled trials to examine the impact of a multi-strategy sustainability intervention to support schools’ sustainment of a physical activity intervention. The proposed research will generate new evidence needed for the partnering organisations to protect their considerable investments to date in physical activity promotion in this setting and will provide seminal evidence for the field globally.
Trial registration
ACTRN12620000372987 version 1 registered 17
th
March 2020. Version 3 (current version) updated 4
th
August 2023.
The objective of this article is to review the MRI and ultrasound appearances of incarcerated uterus.
Incarcerated uterus is a rare but serious complication of pregnancy in which the gravid uterus ...becomes trapped in the posterior pelvis. Characteristic MRI and ultrasound imaging features enable definitive diagnosis of incarcerated uterus, which reduces risks of complications that can lead to maternal and fetal morbidity and mortality.
Sickle cell disease (SCD) is the most prevalent hemoglobinopathy. Survival in patients with SCD has improved over the past few decades. These patients experience a lifetime of repeated acute pain ...crises, which are thought to result from sickling and microvascular occlusions; acute abdominal pain is common. Moreover, repeated crises often lead to organ dysfunction, such as asplenia, hepatic failure, and renal failure. The spleen, liver, biliary system, kidneys, and gastrointestinal tract can all be affected. Patients may undergo CT to further direct clinical management. We review the spectrum of CT imaging findings of abdominal manifestations in patients with SCD, from the acute microvascular occlusive pain crisis to the potential complications and chronic sequelae.
Cervical carcinoma remains a common gynecologic malignancy. Magnetic resonance imaging is a useful and accurate tool in the diagnosis, staging, and follow-up of cervical carcinoma. This article ...describes the optimal techniques for magnetic resonance evaluation of the cervix, illustrates the role of magnetic resonance imaging in patients with known or indicated cervical carcinoma, and describes key aspects of staging and management of cervical carcinoma.
The purpose of this study was to determine whether radiologist-performed electronic order entry affects use of oral contrast material for CT. Contrast media have been classified as medications by The ...Joint Commission, which necessitates a physician order for their administration.
In a retrospective study, rates of use of oral and IV contrast material for inpatient abdominopelvic CT examinations performed 6 months before and 6 months after the date of implementation of computerized physician order entry were calculated. Radiologist perception of order entry time was assessed by survey; order entry time was measured for 10 blinded radiologists. Descriptive, chi-square, and Student t test statistics were used.
A protocol that normally includes oral or IV contrast administration was used for 1693 CT examinations (784 before and 909 after May 25, 2010). No significant change (p > 0.05) was found in ratios of indications for CT, rates of use of IV contrast material, or rates of use of oral contrast material after computerized physician order entry was implemented. The mean perceived order entry time was 3 minutes 3 seconds (weighted average); the actual time was 1 minute 47 seconds (range, 1:19-2:25 minutes). The extrapolated cumulative order entry time was 26 hours 38 minutes of physician time in the 6-month period after computerized physician order entry was started. Most of the survey respondents (98%, 41/42) did not think radiologist order entry improved patient safety, and 43% (18/42) believed it to be very or extremely disruptive.
Mandatory radiologist-performed electronic order entry does not negatively affect the rate of use of oral contrast for inpatient abdominopelvic CT, but it is potentially time-consuming and disliked by participating radiologists.
Benign and malignant uterine masses can be seen in the women. Some of these are asymptomatic and incidentally discovered, whereas others can be symptomatic. With the soft tissue contrast resolution ...magnetic resonance imaging can render a definitive diagnosis, which can further help streamline patient management. In this article we show magnetic resonance imaging examples of benign and malignant masses of the uterus and their treatment strategies.
