Long-Term Peritoneal Indwelling Catheters for Malignant Ascites: A Retrospective Case Series of PleurX and Peritoneal Port.

Objectives: To compare outcomes of PleurX and peritoneal port for malignant ascites. Design: Retrospective review of medical records was conducted. Setting/Subjects: Subjects were consecutive patients receiving PleurX or peritoneal port for malignant ascites in a center in Sydney, Australia. Measurements: Demographic data, complication rates, hospitalization rates, and survival were measured. Results: Sixteen cases were analyzed: 6 had peritoneal port (170 catheter days) and 10 had PleurX (477 catheter days). Complication rates were low with both drainage systems. Cellulitis rate was 33% (1.2 events/100 catheter days) for peritoneal port and 10% (0.2 events/100 catheter days) for PleurX. Hospital admission days were 27 days/100 catheter days for peritoneal port and 5.2 days/100 catheter days for PleurX. Conclusions: Both PleurX and peritoneal port seem feasible options in draining malignant ascites. Further research is needed to ascertain whether there are true differences in cellulitis/admission rates. Patient quality of life, experience, and preference should be included in future studies.

Artefact on CT brain images caused by the presence of air bubbles in the cooling oil of the X-ray tube.

INTRODUCTION: We report a series of patients who had computed tomography (CT) of their brains which showed an uncommon artefact caused by excess air bubbles in the cooling oil around the X-ray tube. METHODS: In November and December 2015, it was recognised that artefacts appearing on CT brain images acquired at our department were caused by a scanner fault. The test images were reviewed and the service engineer for the CT scanner was questioned about the artefact cause. A retrospective audit was then performed of images acquired on the CT scanner from December 2015 back to the date that the CT scanner was last serviced in September 2015 to identify any other scans affected by the artefact. RESULTS: Seven patients were identified whose CT brain scans showed the artefact. The artefact manifested in the form of an ill-defined low density area in varying locations. The artefact also appeared on CT phantom test images. It was discovered to be caused by the presence of excess air bubbles within the cooling oil of the X-ray tube. The fault was then rectified. CONCLUSIONS: The artefact described may not be easily recognised and could lead to misinterpretation and unnecessary investigation. We aim to promote awareness of this artefact and to reinforce the importance of frequent quality control testing of CT systems.

Cetuximab-associated pulmonary toxicity.

There is increasing evidence for the use of epidermal growth factor receptor (EGFR) inhibitors in head and neck, non-small-cell lung, and colorectal cancers. We report the case of a 78-year-old man with metastatic colorectal cancer (CRC) involving liver and lung who received cetuximab plus irinotecan as third-line treatment. Two months later, he presented with signs and symptoms consistent with bronchiolotis obliterans organizing pneumonia secondary to cetuximab. Reports of cetuximab-associated pulmonary toxicity are rare, although there have been extensive reports of interstitial fibrosis with the use of other EGFR inhibitors such as gefitinib and erlotinib. There are many causes of pulmonary infiltrates in patients treated for advanced CRC, and this case highlights the importance of considering drug toxicity.

Bone scintigraphy in acetabular labral tears.

BACKGROUND: Acetabular labral tears are an increasingly recognized cause of hip pain in young adults with hip dysplasia and older patients with degenerative disease of the hips. METHODS: The authors analyzed retrospectively bone scintigraphy in 27 patients with acetabular labral tears diagnosed by MRI/arthroscopy. Analysis was also made of scintigraphy in 30 patients without labral tears being investigated for other causes of hip pain for comparison. RESULTS: Patients with labral tears had hyperemia of the superior or superomedial aspect of the acetabulum and increased delayed uptake in either a focal superior pattern or in an "eyebrow" pattern of a superomedial tear. This pattern was not seen in any other sources of hip pathology. CONCLUSION: Uptake in the superior or superomedial aspect of the acetabular rim is characteristic of a labral tear. Absence of this pattern carries a high negative predictive value for the diagnosis.

Avascular necrosis of the talus.

Persistent pain in the ankle after relatively minor trauma is common and usually resolves spontaneously. Two cases of persistent pain after minor trauma are presented that involved unusual characteristics of scintigraphic and magnetic resonance imaging, compatible with avascular necrosis of the talar body. This is a rare finding in the absence of steroid use or significant trauma to the foot. The unusual vascular anatomy of the talus is considered in the possible mechanism of injury.