Institutional review of glial tumors treated with chemotherapy: the first description of PCV-related pseudoprogression.

BACKGROUND: Pseudoprogression refers to areas of enhancement on MRI postadjuvant chemoradiation that arise as a result of treatment-related effects. Pseudoprogression has been well described with temozolomide-based chemoradiation but has not been studied in the setting of procarbazine, lomustine, and vincristine (PCV) chemotherapy. We reviewed patients treated with PCV to investigate the occurrence of pseudoprogression. METHODS: Adults diagnosed with World Health Organization grade II or III gliomas between 2010 and 2015 and treated with PCV or temozolomide were identified. Patient, tumor, treatment, and MRI data were retrospectively collected and analyzed. Pseudoprogression was defined as new enhancement seen on MRI within 6 months of completion of adjuvant radiotherapy or concurrent chemoradiation, which improved or remained stable on subsequent scans without therapeutic intervention. If MRI showed areas of new enhancement outside the 6-month post-treatment window, which resolved or remained stable without treatment, or in patients who did not receive adjuvant treatment, it was referred to as "atypical pseudoprogression." RESULTS: Fifty-seven patients were identified. Nine (16%) patients were identified as having pseudoprogression on MRI. Two (4%) of these patients were treated with PCV and 7 (12%) were treated with temozolomide. Seventeen (30%) patients had atypical pseudoprogression: 8 (14%) treated with temozolomide, 8 (14%) treated with PCV, and 1 (2%) treated with both types of chemotherapy. CONCLUSIONS: We describe the first 2 cases of PCV-related pseudoprogression and 17 cases of atypical pseudoprogression. As the re-emergence of adjuvant PCV occurs in clinical practice, the occurrence of classical and atypical pseudoprogression could have a significant impact on clinical decision making.

The Great Mimicker: Pseudo-Meig Syndrome in a Pregnant Patient. A Review.

Meig syndrome is the triad of benign ovarian tumor, ascites, and pleural effusion. Pseudo-Meig syndrome mimics the Meig syndrome triad; however, in pseudo-Meig syndrome, the ovarian tumor usually represents a primary malignancy or metastases. Differentiating Meig from pseudo-Meig syndrome is challenging both clinically and with diagnostic imaging but is important because prognoses for these distinct entities are drastically different. Evidence-based sonographic prediction models are valuable because they can aid in this distinction. Here, we present the first reported case of pseudo-Meig syndrome secondary to large, bilateral Krukenberg tumors of unknown origin, in a gravid 30-year-old woman at 24 weeks' gestation, discovered initially by ultrasound.

The risk of inflammatory bowel disease flares after fecal microbiota transplantation: Systematic review and meta-analysis.

Several studies have suggested worsening in inflammatory bowel disease (IBD) activity following fecal microbiota transplantation (FMT). We aimed to assess the risk of worsening in IBD activity following FMT. An electronic search was conducted using MEDLINE (1946-June 2016), EMBASE (1954-June 2016) and Cochrane Central Register of Controlled Trials (2016). Studies in which FMT was provided to IBD patients for IBD management or (Clostridium difficile infection) CDI treatment were included. The primary outcome was the rate of worsening in IBD activity. RESULTS: Twenty-nine studies with 514 FMT-treated IBD patients were included. Range of follow up was 4 weeks to 3 y. The pooled rate of IBD worsening was 14.9% (95% CI 10-21%). Heterogeneity was detected: I2 D 52.1%, Cochran Q test D 58.1, p D 0.01. A priori subgroup analyses were performed. Although not significant, the pooled rate of worsening in IBD activity following FMT for CDI (22.7% (95% CI: 13-36%)) was higher compared with FMT for IBD (11.1% (95% CI 7-17%)). Rates of worsening in IBD after lower GI FMT delivery revealed a higher rate of worsening in IBD activity (16.5% (95% CI: 11-24%)) compared with upper GI delivery (5.6% (95% CI: 2-16%)). Rates of worsening in high quality studies and randomized controls trials (RCTS) suggested a marginal risk of worsening in IBD activity (4.6%, (95% CI: 1.8-11%). Rates of IBD worsening are overall marginal across high quality RCTS. It is unknown if the FMT itself led to the worsening of IBD in this small fraction or if this represents alternative etiologies.

Radiographic interpretation of carpometacarpal arthroplasty: correlation between radiographic loosening and clinical outcome.

OBJECTIVE: To assess the radiographic appearance and interpretation of loosening in patients following first carpometacarpal joint pyrohemisphere arthroplasty. MATERIALS AND METHODS: A retrospective review over a 6-year period was performed identifying patients with first carpometacarpal pyrohemisphere implants. All postoperative radiographs were reviewed and compared with clinical information. Loosening was defined as greater than 1 mm of periprosthetic lucency or increasing lucency on serial studies. Adverse clinical outcome was defined as infection, complex regional pain syndrome, subluxation or an inability to return to activities of daily living. Statistical analysis included Cohen's Kappa coefficient to measure inter-reader agreement for radiographic interpretation and the agreement between radiographic loosening and an undesired or adverse clinical outcome. RESULTS: Thirty-one implants in 26 patients were reviewed. A total of 73 postoperative radiographs were reviewed. The mean age of the study subjects was 58 years. The mean radiographic follow-up was 13 months (range: 1-56). All arthroplasties were performed for osteoarthritis. Only one repeat surgery was performed. There was good agreement amongst readers with regard to radiographic interpretation, but the strength of agreement between radiographic loosening and adverse clinical outcome was poor. The sensitivity of radiography in predicting an adverse clinical outcome was 63%, specificity 65%, positive predictive value 39%, and negative predictive value 83%. CONCLUSION: Although radiography may be useful in the correct clinical context, it should not be utilized as the sole predictor of adverse clinical outcomes following carpometacarpal arthroplasty.

Ectopic Pelvic Fibroid in a Woman With Uterine Agenesis and Mayer-Rokitansky-Küster-Hauser Syndrome.

Mayer-Rokitansky-Küster-Hauser (MRKH) syndrome is a rare disorder characterized by aplasia or hypoplasia of the uterus and vagina due to arrest in the development of the müllerian ducts. Women with this syndrome have the normal 46 XX karyotype, normal female secondary sex characteristics, and primary amenorrhea. Only a few cases have been described in the literature where a fibroid develops from a rudimentary, nonfunctioning uterus in patients with MRKH syndrome. In even rarer instances, a fibroid can develop in patients with a congenitally absent uterus.Here, we present the first reported case of an ectopic fibroid in association with congenital absence of a uterus found by ultrasound in a 66-year-old white female patient with MRKH syndrome and unilateral renal agenesis.

Systematic Review of the Application of Lean and Six Sigma Quality Improvement Methodologies in Radiology.

PURPOSE: Preventable yet clinically significant rates of medical error remain systemic, while health care spending is at a historic high. Industry-based quality improvement (QI) methodologies show potential for utility in health care and radiology because they use an empirical approach to reduce variability and improve workflow. The aim of this review was to systematically assess the literature with regard to the use and efficacy of Lean and Six Sigma (the most popular of the industrial QI methodologies) within radiology. METHODS: MEDLINE, the Allied & Complementary Medicine Database, Embase Classic + Embase, Health and Psychosocial Instruments, and the Ovid HealthStar database, alongside the Cochrane Library databases, were searched on June 2015. Empirical studies in peer-reviewed journals were included if they assessed the use of Lean, Six Sigma, or Lean Six Sigma with regard to their ability to improve a variety of quality metrics in a radiology-centered clinical setting. RESULTS: Of the 278 articles returned, 23 studies were suitable for inclusion. Of these, 10 assessed Six Sigma, 7 assessed Lean, and 6 assessed Lean Six Sigma. The diverse range of measured outcomes can be organized into 7 common aims: cost savings, reducing appointment wait time, reducing in-department wait time, increasing patient volume, reducing cycle time, reducing defects, and increasing staff and patient safety and satisfaction. All of the included studies demonstrated improvements across a variety of outcomes. However, there were high rates of systematic bias and imprecision as per the Grading of Recommendations Assessment, Development and Evaluation guidelines. CONCLUSIONS: Lean and Six Sigma QI methodologies have the potential to reduce error and costs and improve quality within radiology. However, there is a pressing need to conduct high-quality studies in order to realize the true potential of these QI methodologies in health care and radiology. Recommendations on how to improve the quality of the literature are proposed.