Mobile Mitral Valve Vegetations: Not Your Usual Endocarditis.

Mitral annular calcification (MAC) is a chronic degenerative condition that is associated with age, chronic kidney disease, diabetes, dyslipidemia, hypertension, and tobacco use. Mobile calcified lesions can be mistaken for endocarditis on trans-thoracic echocardiogram (TTE), creating a unique diagnostic challenge. In this case, we describe a young dialysis patient who presented with dyspnea on exertion with no obvious etiology on initial work-up. TTE was obtained, which showed mobile lesions on the mitral and aortic valves, initially thought to be endocarditis, but later diagnosed as MAC. Trans-esophageal echocardiography (TEE) is a useful modality to differentiate mobile masses on the mitral valve.

"Was It Worth It?": A Pilot Study in Patient Perspectives on the Worthwhileness of Radiation Therapy.

OBJECTIVES: Radiation therapy is a core oncologic treatment, but literature detailing patient satisfaction post-treatment is sparse. The authors conducted a pilot study to determine whether a simple survey would be feasible to administer and could elucidate factors predictive of satisfaction with radiotherapy. MATERIALS AND METHODS: Patients with cancer receiving radiotherapy in an academic radiation oncology department from 2014 to 2015 received a 4-item radiotherapy-focused version of the "Was It Worth It?" questionnaire (r-WIWI) on the last day of treatment and at the first follow-up. Univariate analysis and logistic regression modeling were performed on collected patient and treatment characteristics to explore predictors of satisfaction. RESULTS: Two hundred patients completed an r-WIWI questionnaire at treatment completion and 60 at the time of the first follow-up. Seventy-one percent and 90% of patients found radiotherapy worthwhile on the last day of treatment and at first follow-up, respectively. Patients treated during the morning and for a longer duration as measured in elapsed days were more likely to report treatment being worthwhile. Age, sex, race, marital status, employment status, treatment intent or modalities, daily radiation treatment delays, distance traveled, insurance type, site of treatment, and cancer stage were not predictive of patient satisfaction. CONCLUSIONS: The r-WIWI survey was feasible to administer and most patients reported treatment being worthwhile on the last day of treatment and at first follow-up. Morning treatment times and longer treatment duration as measured in elapsed days were predictive of higher satisfaction in this pilot study. A broader study of factors associated with patient satisfaction with radiotherapy using the r-WIWI is indicated.