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1.
Radiographics ; 36(5): 1579-96, 2016.
Article in English | MEDLINE | ID: mdl-27618331

ABSTRACT

Pelvic inflammatory disease (PID) is a common medical problem, with almost 1 million cases diagnosed annually. Historically, PID has been a clinical diagnosis supplemented with the findings from ultrasonography (US) or magnetic resonance (MR) imaging. However, the diagnosis of PID can be challenging because the clinical manifestations may mimic those of other pelvic and abdominal processes. Given the nonspecific clinical manifestations, computed tomography (CT) is commonly the first imaging examination performed. General CT findings of early- and late-stage PID include thickening of the uterosacral ligaments, pelvic fat stranding with obscuration of fascial planes, reactive lymphadenopathy, and pelvic free fluid. Recognition of these findings, as well as those seen with cervicitis, endometritis, acute salpingitis, oophoritis, pyosalpinx, hydrosalpinx, tubo-ovarian abscess, and pyometra, is crucial in allowing prompt and accurate diagnosis. Late complications of PID include tubal damage resulting in infertility and ectopic pregnancy, peritonitis caused by uterine and/or tubo-ovarian abscess rupture, development of peritoneal adhesions resulting in bowel obstruction and/or hydroureteronephrosis, right upper abdominal inflammation (Fitz-Hugh-Curtis syndrome), and septic thrombophlebitis. Recognition of these late manifestations at CT can also aid in proper patient management. At CT, careful assessment of common PID mimics, such as endometriosis, adnexal torsion, ruptured hemorrhagic ovarian cyst, adnexal neoplasms, appendicitis, and diverticulitis, is important to avoid misinterpretation, delay in management, and unnecessary surgery. Correlation with the findings from complementary imaging examinations, such as US and MR imaging, is useful for establishing a definitive diagnosis. (©)RSNA, 2016.


Subject(s)
Multimodal Imaging , Pelvic Inflammatory Disease/diagnostic imaging , Pelvic Inflammatory Disease/pathology , Tomography, X-Ray Computed , Diagnosis, Differential , Female , Humans , Magnetic Resonance Imaging , Ultrasonography
2.
J Am Coll Radiol ; 12(3): 249-55, 2015 Mar.
Article in English | MEDLINE | ID: mdl-25743922

ABSTRACT

PURPOSE: The aim of this study was to measure women's knowledge of breast density and their attitudes toward supplemental screening tests in the setting of the California Breast Density Notification Law at an academic facility and a county hospital, serving women with higher and lower socioeconomic status, respectively. METHODS: Institutional review board exemptions were obtained. A survey was administered during screening mammography at two facilities, assessing women's awareness of and interest in knowing their breast density and interest in and willingness to pay for supplemental whole breast ultrasound and contrast-enhanced spectral mammography (CEMG). The results were compared by using Fisher exact tests between groups. RESULTS: A total of 105 of 130 and 132 of 153 women responded to the survey at the academic and county facilities, respectively. Among respondents at the academic and county facilities, 23% and 5% were aware of their breast density, and 94% and 79% wanted to know their density. A majority were interested in supplemental ultrasonography and CEMG at both sites; however, fewer women had a willingness to pay for the supplemental tests at the county hospital compared with those at the academic facility (22% and 70%, respectively, for ultrasound, P < .0001; 20% and 65%, respectively, for CEMG, P < .0001). CONCLUSIONS: Both groups of women were interested in knowing their breast density and in supplemental screening tests. However, women at the county hospital were less willing to incur out-of-pocket expenses, suggesting a potential for a disparity in health care access for women of lower socioeconomic status after the enactment of breast density notification legislation.


Subject(s)
Academic Medical Centers/statistics & numerical data , Breast Neoplasms/diagnosis , Early Detection of Cancer/statistics & numerical data , Health Literacy/statistics & numerical data , Hospitals, County/statistics & numerical data , Patient Participation/statistics & numerical data , Absorptiometry, Photon/economics , Absorptiometry, Photon/statistics & numerical data , Adult , California/epidemiology , Disease Notification/legislation & jurisprudence , Disease Notification/statistics & numerical data , Early Detection of Cancer/economics , Female , Health Care Surveys , Humans , Informed Consent/legislation & jurisprudence , Informed Consent/statistics & numerical data , Mammography/economics , Mammography/statistics & numerical data , Middle Aged , Patient Education as Topic/statistics & numerical data , Patient Participation/economics , Socioeconomic Factors
3.
Pediatr Nephrol ; 27(11): 2081-2090, 2012 Nov.
Article in English | MEDLINE | ID: mdl-22907601

ABSTRACT

BACKGROUND: Mutations in the K(+) channel KCNJ10 (Kir4.1) cause an autosomal recessive syndrome featuring seizures, sensorineural deafness, ataxia, mental retardation, and electrolyte imbalance (SeSAME). Kir4.1 localizes to the basolateral membrane of the renal distal convoluted tubule, and its loss of function mimics renal features of Gitelman syndrome, with hypokalemic alkalosis, hypomagnesemia, and hypocalciuria. Presentation early in life due to seizures provides an opportunity to investigate the development of the electrolyte defect with age. METHODS: We used DNA sequencing, electrophysiology, confocal imaging, and biochemistry to identify a new KCNJ10 mutation in a previously unreported family and determine its impact on channel function. We examined medical records to follow the development of electrolyte disorders with age. RESULTS: The four affected members were all homozygous for a novel T57I mutation that confers biochemical loss-of-function. Electrolytes in affected children were normal in the first years of life but showed significant worsening with age, resulting in clinically significant defects at age 5-8 years. Similar findings were seen in other SeSAME patients. CONCLUSIONS: These findings provide evidence for a delayed activity of salt reabsorption by the distal convoluted tubule and suggest an explanation for the delayed clinical presentation of subjects with Gitelman syndrome.


Subject(s)
Hearing Loss, Sensorineural/metabolism , Intellectual Disability/metabolism , Kidney Tubules, Distal/metabolism , Potassium Channels, Inwardly Rectifying/metabolism , Seizures/metabolism , Absorption , Age Factors , Biomarkers/blood , Child , DNA Mutational Analysis , Electrolytes/blood , Female , Genetic Predisposition to Disease , HEK293 Cells , Hearing Loss, Sensorineural/genetics , Hearing Loss, Sensorineural/therapy , Homozygote , Humans , Infant , Intellectual Disability/genetics , Intellectual Disability/therapy , Male , Membrane Potentials , Microscopy, Confocal , Mutation , Pedigree , Phenotype , Potassium Channels, Inwardly Rectifying/genetics , Predictive Value of Tests , Seizures/genetics , Seizures/therapy , Transfection
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