ABSTRACT
An interesting case report detailing the management of an aorta that was inadvertently screwed during spinal fixation. The management and imaging encompass the use of computer tomography and intravascular ultrasound to determine the trajectory of the screw and the successful management of the patient.
Subject(s)
Aorta, Thoracic/surgery , Blood Vessel Prosthesis Implantation , Bone Screws/adverse effects , Endovascular Procedures , Orthopedic Procedures/adverse effects , Thoracic Vertebrae/surgery , Vascular System Injuries/surgery , Adult , Aorta, Thoracic/diagnostic imaging , Aorta, Thoracic/injuries , Aortography/methods , Blood Vessel Prosthesis , Blood Vessel Prosthesis Implantation/instrumentation , Endovascular Procedures/instrumentation , Humans , Male , Orthopedic Procedures/instrumentation , Reoperation , Stents , Tomography, X-Ray Computed , Treatment Outcome , Ultrasonography, Interventional , Vascular System Injuries/diagnosis , Vascular System Injuries/etiologyABSTRACT
INTRODUCTION: Due to increased awareness of breast cancer resulting in early detection, there is a decreased incidence nationwide of late-stage breast cancer, including that which presents with skin involvement (T4b). METHODS: A retrospective analysis of a 10-month period from August 2007 to May 2008 at Howard University Hospital (HUH), Washington, DC, revealed 12 patients diagnosed with T4b breast cancer and compared to similarly staged patients in the Surveillance, Epidemiology, and End Results (SEER) database. Finally, a logistic regression for the likelihood of T4b diagnosis was performed patients in the SEER database. RESULTS: HUH patients with T4b tumors were more likely than SEER patients to present with predictors of poor clinical outcome, including high-grade histology (100% vs 59.4%, p = .04) and estrogen receptor- (75% vs 30.3%, p = .001) and progesterone receptor- negative (91.7% vs 43.9%, p = .001) status. Conversely, HUH patients were younger (57.8 y vs 66.3 y, p = .03) and had smaller tumors (11.1 cm vs 28.2 cm, p = .02) than SEER patients with similarly staged tumors. Older patients (OR, 2.36; 95% CI, 1.50-2.00; p < .001; 60-80 y), African American patients (OR, 1.63; 95% CI, 1.26-2.11; p < .001), and patients with high-grade (OR, 5.51; 95% CI, 3.88-6.52; p < .001) tumors were more likely to be diagnosed with T4b tumors, whereas patients who lived in an area with increased median household income (OR, 0.99; 95% CI, 0.99-0.99; p = .001) were less likely to be diagnosed with a T4b lesion. CONCLUSION: While much research has focused on the socioeconomic causes for the development of T4b tumors, both patient and tumor biologic conditions cannot be eliminated as causative agents.
