Introducing First-Year Radiology Residents to the ACR at the AMCLC From 2009 to 2013: Summary of Experiences and Five-Year First-Cohort Follow-Up.

PURPOSE: The aim of this report is to provide a five-year summary of the Minnesota Radiological Society's initiative to send first-year radiology residents to the ACR at the AMCLC. The authors provide an update of the survey data for the first five years (2009-2013) and a report of the ACR membership status of the original 2009 cohort (class of 2012) five years after their conference experience. METHODS: Participating residents from 2009 to 2013 completed pre- and postconference surveys assessing their knowledge of ACR-related topics, conference satisfaction, and intention to join the ACR. ACR membership status of the first cohort was determined using the ACR membership database and compared with both the previous five graduating classes and the national average for practicing radiologists. RESULTS: Seventy first-year Minnesota radiology residents attended the conference from 2009 to 2013. Knowledge of the ACR significantly increased after the conference. Most residents were highly satisfied or satisfied with their conference experience and highly likely or likely to join the ACR in the future. Two years after residency, 87% of the first cohort (13 of 15) were ACR members, compared with an average membership rate of 57% (63 of 110) for the previous five graduating classes. CONCLUSIONS: Exposing radiology residents early to the ACR at the AMCLC leads to a significant increase in knowledge pertaining to the professional organization. This exposure likely leads to increased ACR membership when residents enter practice. This early engagement in radiology affairs can lead to a higher rate of ACR membership and to a better informed membership.

Emergence of imatinib resistance associated with downregulation of c-kit expression in recurrent gastrointestinal stromal tumor (GIST): optimal timing of resection.

INTRODUCTION: Gastrointestinal stromal tumors (GISTs) are the most common gastrointestinal mesenchymal tumors. The activating mutation in the KIT (c-kit; CD117) proto-oncogene with subsequent tyrosine kinase activation plays a central role in the pathogenesis of GIST. Tyrosine kinase inhibitors are an integral part of GIST therapy. Initial response to neoadjuvant imatinib can be expected in up to 70% of the patients, thus offering an opportunity to surgically treat those with locally advanced primary or recurrent GIST. This favorable response to imatinib, however, is plagued with development of secondary resistance during the course of therapy. CASE DESCRIPTION: We herein report a case of recurrent locally advanced GIST in an elderly man, with excellent performance status, successfully managed with the integration of neoadjuvant targeted therapy and surgery. DISCUSSION: Continued monitoring by a multidisciplinary team, including a surgeon, is vital for the success of neoadjuvant imatinib therapy for unresectable primary or recurrent GIST in the context of emergence of secondary resistance. As such, surgeons should participate in managing imatinib-treated GIST, as resection may become a viable curative option. This case also highlights that major oncologic resections can be safely performed in older persons when their performance status and comorbidities are carefully considered.

Immediate repair compared with surveillance of small abdominal aortic aneurysms.

BACKGROUND: Whether elective surgical repair of small abdominal aortic aneurysms improves survival remains controversial. METHODS: We randomly assigned patients 50 to 79 years old with abdominal aortic aneurysms of 4.0 to 5.4 cm in diameter who did not have high surgical risk to undergo immediate open surgical repair of the aneurysm or to undergo surveillance by means of ultrasonography or computed tomography every six months with repair reserved for aneurysms that became symptomatic or enlarged to 5.5 cm. Follow-up ranged from 3.5 to 8.0 years (mean, 4.9). RESULTS: A total of 569 patients were randomly assigned to immediate repair and 567 to surveillance. By the end of the study, aneurysm repair had been performed in 92.6 percent of the patients in the immediate-repair group and 61.6 percent of those in the surveillance group. The rate of death from any cause, the primary outcome, was not significantly different in the two groups (relative risk in the immediate-repair group as compared with the surveillance group, 1.21; 95 percent confidence interval, 0.95 to 1.54). Trends in survival did not favor immediate repair in any of the prespecified subgroups defined by age or diameter of aneurysm at entry. These findings were obtained despite a low total operative mortality of 2.7 percent in the immediate-repair group. There was also no reduction in the rate of death related to abdominal aortic aneurysm in the immediate-repair group (3.0 percent) as compared with the surveillance group (2.6 percent). Eleven patients in the surveillance group had rupture of abdominal aortic aneurysms (0.6 percent per year), resulting in seven deaths. The rate of hospitalization related to abdominal aortic aneurysm was 39 percent lower in the surveillance group. CONCLUSIONS: Survival is not improved by elective repair of abdominal aortic aneurysms smaller than 5.5 cm, even when operative mortality is low.