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1.
Case Rep Oncol Med ; 2016: 8125898, 2016.
Article in English | MEDLINE | ID: mdl-27994899

ABSTRACT

Introduction. Patients with urothelial carcinoma of the bladder often present with metastases to regional lymph nodes, with lymphadenopathy on physical examination or radiographic imaging. Case Presentation. We present the case of a 73-year-old Caucasian man with presumed metastatic urothelial carcinoma of the bladder to regional pelvic and retroperitoneal lymph nodes. He underwent systemic chemotherapy for treatment of urothelial carcinoma and was discovered on restaging to have findings suggestive of disease progression but ultimately was found to have a concurrent secondary malignancy. Conclusion. Our case suggests that in patients with urothelial carcinoma, the concurrent presentation of regional lymphadenopathy may not be metastatic urothelial carcinoma and may warrant further investigation.

2.
Gastrointest Endosc ; 84(3): 408-15, 2016 Sep.
Article in English | MEDLINE | ID: mdl-26907745

ABSTRACT

BACKGROUND AND AIMS: Peroral endoscopic myotomy (POEM) is a procedure with potential for serious adverse events. Postprocedure imaging is routinely done, yet there is no consensus on the optimal imaging protocol. We describe a novel and simple CT esophagram protocol for evaluation after POEM and for reporting the full spectrum of radiographic findings and subsequent interventions. METHODS: This was a single-center prospective study of consecutive patients treated with POEM evaluated with CT esophagram. RESULTS: Eighty-four consecutive patients who had POEM performed underwent CT esophagrams. The most common findings were pneumomediastinum (85.7%), pneumoperitoneum (66.7%), subcutaneous emphysema (52.4%), and pleural effusion (46.4%). Other findings included retroperitoneal air (38.1%), pneumothorax (19%), atelectasis (14.3%), intramural air in the esophagus and/or stomach (13.1%), pericardial effusion (2.4%), and pneumopericardium (2.4%). Five patients required intervention based on CT findings. In 1 patient, a leak was detected on CT esophagram before any clinical manifestation, facilitating prompt intervention and avoiding potential serious outcomes. Four patients were diagnosed with pneumonia and were treated with antibiotics. There was frequent postprocedural atelectasis, which prompted the introduction of routine incentive spirometry in all postoperative POEM cases. CONCLUSIONS: CT esophagram is a simple and accessible imaging test for routine postoperative POEM evaluation. Numerous and dramatic postprocedure radiographic findings may be expected and demonstrated with this imaging modality. Although most of these findings may not require intervention, some are of potential significance, and early identification may help modify postprocedure management. ( CLINICAL TRIAL REGISTRATION NUMBER: NCT01832779.).


Subject(s)
Esophageal Achalasia/surgery , Esophageal Sphincter, Lower/surgery , Adult , Aged , Aged, 80 and over , Endoscopy, Digestive System , Esophageal Achalasia/diagnostic imaging , Esophageal Sphincter, Lower/diagnostic imaging , Esophagus/diagnostic imaging , Esophagus/surgery , Female , Humans , Male , Mediastinal Emphysema/diagnostic imaging , Middle Aged , Natural Orifice Endoscopic Surgery , Operative Time , Pleural Effusion/diagnostic imaging , Pneumoperitoneum/diagnostic imaging , Pneumothorax/diagnostic imaging , Postoperative Complications/diagnostic imaging , Postoperative Period , Prospective Studies , Stomach/diagnostic imaging , Stomach/surgery , Subcutaneous Emphysema/diagnostic imaging , Tomography, X-Ray Computed , Treatment Outcome , Young Adult
3.
J Gastrointest Surg ; 16(12): 2294-6, 2012 Dec.
Article in English | MEDLINE | ID: mdl-23093448

ABSTRACT

INTRODUCTION: Minimally invasive surgical approaches have only recently been applied to pancreatic adenocarcinoma. DISCUSSION: Significant apprehension exists that minimally invasive pancreatic surgery will not lead to equivalent or superior oncologic outcomes compared to traditional surgical approaches. This is the first case report of a port-site recurrence following laparoscopic pancreaticoduodenectomy.


Subject(s)
Abdominal Wall , Adenocarcinoma/surgery , Laparoscopy , Neoplasms, Second Primary , Pancreatic Neoplasms/surgery , Pancreaticoduodenectomy/methods , Adenocarcinoma/diagnosis , Adenocarcinoma/etiology , Female , Humans , Middle Aged , Neoplasms, Second Primary/diagnosis , Neoplasms, Second Primary/etiology
5.
Am J Clin Oncol ; 32(5): 499-503, 2009 Oct.
Article in English | MEDLINE | ID: mdl-19528792

ABSTRACT

PURPOSE: Scarring in the tumor bed may mask or mimic local recurrence of tumor on surveillance mammography. Type of surgical closure technique used during lumpectomy may impact the pattern or density of scar tissue apparent in the tumor bed on mammography. This study sought to determine whether surgical closure type affects tumor-bed scar formation and impacts interpretation of surveillance mammography in women treated with breast-conserving therapy for early-stage breast cancer. MATERIALS AND METHODS: One hundred women who received breast-conserving therapy were selected; 99 of them had 2-year post-treatment mammograms for the treated breast. Craniocaudal and mediolateral oblique views were reviewed by 3 subspecialty radiologists who routinely read mammograms. The mammograms were scored on 5-point scales for overall breast density and scarring within the tumor bed. RESULTS: The analyses did not demonstrate greater scarring or density in breast status post superficial closure compared with breast status post full-thickness closure, or vice versa (P > 0.05 for scarring and density). There were no detectable differences between the 2 closure techniques either within the data from individual reviewers, within the composite data for the entire group of reviewers, or in instances where 2 of 3 reviewers agreed (P > 0.05). There was significant interobserver variability in scoring among the mammographers for both scarring (P = 0.001) and density (P < 0.0001). CONCLUSION: Based on our study of the 2-year post-treatment mammograms, there was no evidence that closure technique impacts degree of scarring in the tumor bed. However, striking interobserver variability in scoring density and scarring was noted.


Subject(s)
Breast Neoplasms/surgery , Breast/pathology , Cicatrix/diagnostic imaging , Mammography , Mastectomy, Segmental/methods , Neoplasm Recurrence, Local/diagnostic imaging , Wound Closure Techniques , Adult , Aged , Breast Neoplasms/diagnostic imaging , Cicatrix/pathology , Early Detection of Cancer , Female , Humans , Middle Aged , Observer Variation , Recurrence
6.
Ann Surg ; 241(6): 1016-21 ;discussion 1021-3, 2005 Jun.
Article in English | MEDLINE | ID: mdl-15912051

ABSTRACT

OBJECTIVE: To evaluate the outcome of aggressive conservative therapy in patients with esophageal perforation. SUMMARY BACKGROUND DATA: The treatment of esophageal perforation remains controversial with a bias toward early primary repair, resection, and/or proximal diversion. This review evaluates an alternate approach with a bias toward aggressive drainage of fluid collections and frequent CT and gastographin UGI examinations to evaluate progress. METHODS: From 1992 to 2004, 47 patients with esophageal perforation (10 proximal, 37 thoracic) were treated (18 patients early [<24 hours], 29 late). There were 31 male and 16 females (ages 18-90 years). The etiology was iatrogenic (25), spontaneous (14), trauma (3), dissecting thoracic aneurysm (3), and 1 each following a Stretta procedure and Blakemore tube placement. RESULTS: Six of 10 cervical perforations underwent surgery (3 primary repair, 3 abscess drainage). Nine of 10 perforations healed at discharge. In 37 thoracic perforations, 2 underwent primary repair (1 iatrogenic, 1 spontaneous) and 4 underwent limited thoracotomy. Thirty-4 patients (4 cervical, 28 thoracic) underwent nonoperative treatment. Thirteen of the 14 patients with spontaneous perforation (thoracic) underwent initial nonoperative care. Overall mortality was 4.2% (2 of 47 patients). These deaths represent 2 of 37 thoracic perforations (5.4%). There were no deaths in the 34 patients treated nonoperatively. Esophageal healing occurred in 43 of 45 surviving patients (96%). Subsequent operations included colon interposition in 2, esophagectomy for malignancy in 3, and esophagectomy for benign stricture in 2. CONCLUSIONS: Aggressive treatment of sepsis and control of esophageal leaks leak lowers mortality and morbidity, allow esophageal healing, and avoid major surgery in most patients.


Subject(s)
Esophageal Perforation/surgery , Adolescent , Adult , Aged , Aged, 80 and over , Chest Tubes , Contrast Media , Diatrizoate Meglumine , Drainage , Esophageal Perforation/diagnosis , Esophageal Perforation/etiology , Esophageal Perforation/mortality , Female , Humans , Iatrogenic Disease , Length of Stay , Male , Middle Aged , Morbidity , Retrospective Studies , Wound Healing
7.
Breast J ; 10(1): 48-53, 2004.
Article in English | MEDLINE | ID: mdl-14717760

ABSTRACT

Primary granulocytic sarcoma (GS) is a rare entity, and even more unusual is the presence of primary GS of the breast. We describe such a case and report on the 19 cases of primary breast GS in the literature. Primary GS presents most commonly in skin and lymph nodes, therefore when it presents in the breast, misdiagnosis is a common problem. Primary breast GS is misdiagnosed most frequently as lymphoma or sarcoma. Histologic testing and immunostains are essential to provide the proper diagnosis. It appears that early initiation of systemic acute myelogenous leukemia (AML)-type chemotherapy is beneficial and may delay or avert the development of AML in bone marrow and blood.


Subject(s)
Breast Neoplasms/diagnosis , Sarcoma, Myeloid/diagnosis , Antineoplastic Combined Chemotherapy Protocols/administration & dosage , Breast Neoplasms/diagnostic imaging , Breast Neoplasms/drug therapy , Breast Neoplasms/pathology , Diagnosis, Differential , Female , Humans , Leukemia, Myeloid, Acute , Mammography , Middle Aged , Sarcoma, Myeloid/diagnostic imaging , Sarcoma, Myeloid/drug therapy , Sarcoma, Myeloid/pathology
8.
Clin Liver Dis ; 6(1): 17-28, 2002 Feb.
Article in English | MEDLINE | ID: mdl-11933588

ABSTRACT

Sonography is highly useful in evaluating the patient with severe liver disease before and after the placement of a TIPS and before and after organ transplantation. Efforts to use ultrasound imaging to evaluate for primary and metastatic lesions to the liver have been reviewed. With its Doppler and color flow capabilities, ultrasound imaging will remain an important modality for hepatic imaging, especially in the evaluation of portal vein patency and hepatic artery thrombosis.


Subject(s)
Liver Diseases/diagnostic imaging , Liver/diagnostic imaging , Humans , Liver Diseases/surgery , Liver Neoplasms/diagnostic imaging , Liver Neoplasms/secondary , Liver Transplantation , Portasystemic Shunt, Transjugular Intrahepatic , Preoperative Care , Ultrasonography
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