Porocarcinoma of the Groin: A Case Report.

Introduction: Porocarcinoma is a rare skin cancer that arises from the intraepidermal ducts of sweat glands. It is classically found in the 60-70-year-old age group, and lesions are most commonly reported on the head and neck or lower extremities. Case Presentation: This case focuses on a 49-year-old man who presented to an outpatient dermatology clinic with a growing, painful nodule in his right groin. A shave biopsy was conducted and resulted in a diagnosis of a porocarcinoma. Conclusion: Porocarcinoma is an extremely rare skin cancer that most commonly occurs on the head, neck, or lower extremities of 60-70-year-olds. This report details the interesting findings of a porocarcinoma in an unexpected location and age group and reviews pertinent literature.

Excimer Laser Therapy for Pigmented Purpuric Dermatosis: A Case Study.

BACKGROUND Pigmented purpuric dermatosis (PPD) is a rare disease that is poorly understood but thought to result from inflammation of the capillaries causing extravasation of erythrocytes into the soft tissue. There are a variety of potential causes, including medications, such as acetaminophen and aspirin, abnormal humoral immunity, and excessive exercise. Although benign, PPD can be bothersome to patients due to associated pruritus, weeping, and poor cosmetic results. Treatment of this lesion is difficult, with no standardized regimen and a tendency for relapse once treatment is discontinued. CASE REPORT This case reports on a 77-year-old man who presented to an outpatient dermatology clinic with bilateral lower extremity edema with associated weeping and erythema for 1 year. A biopsy was conducted and resulted as PPD. He began treatment with excimer laser therapy after conservative and topical treatment options failed, with resolution of symptoms without recurrence for approximately 1 year. CONCLUSIONS PPD is notoriously difficult to treat, and historic treatment options include topical corticosteroids, oral supplements, and immunomodulators, all of which come with a range of adverse effects. However, new literature supports the use of phototherapy to treat PPD, with varying results. Previously implemented options include but are not limited to phototherapy with psoralen plus ultraviolet A, narrow band ultraviolet B, advanced fluorescence technology pulsed light, and fractional non-ablative 1540-nm erbium: glass laser, each with varying degrees of success. This case discusses the successful treatment of recalcitrant PPD with excimer laser therapy and maintenance of remission for approximately 1 year.

Association between social determinants of health and pediatric traumatic brain injury outcomes.

Introduction: Social determinants of health (SDH) are factors that may impact outcomes following pediatric traumatic brain injuries (TBI). The purpose of this study was to investigate the relationship between race and functional outcomes in a diverse pediatric population. We further explored how this association may be modified by SDH factors, including insurance status, social vulnerability, and child opportunity. Methods: A cohort study (N = 401) of children aged 0-18 [median = 9.22 years (IQR: 3.56-13.59)] presenting to the Emergency Department at Level I and II Trauma Centers with mild to severe head injuries. Geocoded variables were used to evaluate SDH. The sample was described overall and by racial/ethnic group, which were adjusted for confounders using inverse propensity treatment weights (IPTW). Weighted and unweighted Firth logistic regression models (mortality) and generalized linear regression models (GOS-E scores) were reported without and then with potential effect modifiers. Results: The sample is majority male (65.84%); race/ethnicity are as follows: White (52.37%), Black/African Americans (35.91%), and Hispanic (11.72%). Black (31.25%) and Hispanic (27.66%) patients had higher rates of severe TBI. 35.89% of White patients were categorized as more socially vulnerable compared to 62.68% Black and 70.21% Hispanic patients. A total 63.64% of White patients were from higher opportunity neighborhoods, compared to 25.87% of Black and 51.06% of Hispanic patients. A total 50.95% of White patients, 25.87% of Black patients, and 17.02% of Hispanic patients were privately insured. There were no differences found between racial and ethnic groups on mortality or GOS-E scores. Discussion: Patients from minority backgrounds had more severe injuries, many resulting from pedestrian vs. motor vehicle accidents. Additionally, patients from minority backgrounds experience more social vulnerability and lower opportunity. Despite these discrepancies, we did not observe differences on rates of mortality or functional outcomes in either racial or ethnic groups. SDH were not found to impact outcomes. Further research is needed to determine how these complex social and environmental variables impact health outcomes.

Repair of a Large Nasal Ala and Medial Cheek Defect: Case Report.

Introduction: Mohs micrographic surgery is a complex but essential aspect of functional and cosmetic skin cancer removal. It allows for skin cancers to be removed from cosmetically challenging areas in the most efficient and effective possible method; however, closure of these lesions can be difficult. Case: An 80-year-old male presented for Mohs surgery of a basal cell carcinoma on the right nasal sidewall that measured 3.4 cm. The patient underwent seven stages of Mohs surgery, and the final defect measured 6.5 cm × 5.5 cm, resulting in a large area for closure with multiple cosmetic and functional units affected. Discussion: This case discusses options for complex closure of large defects on the nose and the reasoning behind the final choice in closure.

Integration of Art Into Radiological Societies & Educational Conferences: Early Experiences of the 2021 ACR Art Task Force.

Interest in incorporating art into radiology has been growing in recent years. Radiological societies have begun to acknowledge the benefits art can bring to our field. Given this growing interest, a task force was created in 2021 to carry out integration of the arts into the annual American College of Radiology (ACR) meeting. Experiences of this task force are described, including consideration of benefits of integrating art in radiology practice and education as well as strategies, outcomes, and future directions for melding arts with radiology.

Osteopontin as a biomarker for COVID-19 severity and multisystem inflammatory syndrome in children: A pilot study.

This study sought to evaluate the candidacy of plasma osteopontin (OPN) as a biomarker of COVID-19 severity and multisystem inflammatory condition in children (MIS-C) in children. A retrospective analysis of 26 children (0-21 years of age) admitted to Children's Healthcare of Atlanta with a diagnosis of COVID-19 between March 17 and May 26, 2020 was undertaken. The patients were classified into three categories based on COVID-19 severity levels: asymptomatic or minimally symptomatic (control population, admitted for other non-COVID-19 conditions), mild/moderate, and severe COVID-19. A fourth category of children met the Centers for Disease Control and Prevention's case definition for MIS-C. Residual blood samples were analyzed for OPN, a marker of inflammation using commercial ELISA kits (R&D), and results were correlated with clinical data. This study demonstrates that OPN levels are significantly elevated in children hospitalized with moderate and severe COVID-19 and MIS-C compared to OPN levels in mild/asymptomatic children. Further, OPN differentiated among clinical levels of severity in COVID-19, while other inflammatory markers including maximum erythrocyte sedimentation rate, C-reactive protein and ferritin, minimum lymphocyte and platelet counts, soluble interleukin-2R, and interleukin-6 did not. We conclude OPN is a potential biomarker of COVID-19 severity and MIS-C in children that may have future clinical utility. The specificity and positive predictive value of this marker for COVID-19 and MIS-C are areas for future larger prospective research studies.

Passive acoustic monitoring of killer whales (Orcinus orca) reveals year-round distribution and residency patterns in the Gulf of Alaska.

Killer whales (Orcinus orca) are top predators throughout the world's oceans. In the North Pacific, the species is divided into three ecotypes-resident (fish-eating), transient (mammal-eating), and offshore (largely shark-eating)-that are genetically and acoustically distinct and have unique roles in the marine ecosystem. In this study, we examined the year-round distribution of killer whales in the northern Gulf of Alaska from 2016 to 2020 using passive acoustic monitoring. We further described the daily acoustic residency patterns of three killer whale populations (southern Alaska residents, Gulf of Alaska transients, and AT1 transients) for one year of these data. Highest year-round acoustic presence occurred in Montague Strait, with strong seasonal patterns in Hinchinbrook Entrance and Resurrection Bay. Daily acoustic residency times for the southern Alaska residents paralleled seasonal distribution patterns. The majority of Gulf of Alaska transient detections occurred in Hinchinbrook Entrance in spring. The depleted AT1 transient killer whale population was most often identified in Montague Strait. Passive acoustic monitoring revealed that both resident and transient killer whales used these areas much more extensively than previously known and provided novel insights into high use locations and times for each population. These results may be driven by seasonal foraging opportunities and social factors and have management implications for this species.

Addressing the ACGME Mandate for Healthcare Disparities Education in Residency Programs: A Needs Assessment.

PURPOSE: To assess current opinions and efforts from radiology residency program leadership regarding healthcare disparities (HCD) education for residents. METHODS: Radiology residency program directors across the United States were sent a 10-item survey and asked a series of qualitative questions regarding their opinions about HCD and current methods of implementation into their residency curriculum, in addition to demographic information such as program location and setting. RESULTS: 73 out of 334 program directors responded. 49.3% were located in the Northeast, 16.4% in the Southeast, 16.4% in the Midwest, 12.3% in the Southwest, and 5.5% in the Pacific. Community programs made up 16.4% of respondents, while academic programs made up 76.7%. 6.8% identified as "other". 98.6% agreed with the provided definition of HCD. 83.6% agreed or strongly agreed that HCD present an obstacle to providing imaging care. 74.0% agreed or strongly agreed that HCD education is an essential component of residency training. However, 74.0% agreed or strongly agreed that HCD education is difficult to implement due to competing educational requirements. Only 16.4% agreed or strongly agreed that they had sufficient material on HCD to train residents. CONCLUSION: Although many radiology residency programs agree that HCD education is essential in residency training, the majority feel that a curriculum is difficult to implement and that they lack sufficient resources. This study confirms the need to address this gap with a standardized curriculum which has been developed and is discussed.

Analysis of Literature Regarding Health Care Disparities in Radiology: Is Radiology Falling Behind?

PURPOSE: To quantify the gap between radiology and other specialties regarding the amount of literature on healthcare disparities (HCD). METHODS: Four different searches were conducted to evaluate the amount of literature on HCD in radiology as compared to internal medicine and surgery. Initially, the Journal Citation Report was utilized to search for the five highest ranking journals in each field and a second search used impact factor. A combination of search terms "health" AND "disparities" was used. Two additional searches were performed with PubMed using the terms "health" AND "disparities AND "radiology" with the final term changed for each specialty. The second PubMed search added the term "medical education" for each specialty. Articles were limited to years 2017 to 2020. RESULTS: The initial search found 1817 articles discussing "health" and "disparities". 14.6% of these were radiology, 65.7% internal medicine, and 19.7% surgery. The subsequent search controlling for impact factor found 2176 articles. 12.2% were for radiology, 66.1% were for internal medicine, and 21.7% for surgery. The initial PubMed search found 6543 articles. 9.9% were for radiology, 32.4% for internal medicine, and 57.7% were for surgery. The addition of "medical education" decreased the articles to 807. Radiology had 9.9%, internal medicine was 44.2%, and surgery was 45.9 %. CONCLUSION: A gap in HCD literature exists for radiology as compared to surgery and internal medicine. However, radiology has demonstrated a recent significant push towards understanding HCD.  Radiology should continue to capitalize on its momentum and develop HCD curricula and research.

Soft Release Translocation of Texas Horned Lizards (Phrynosoma cornutum) on an Urban Military Installation in Oklahoma, United States.

Wildlife translocation is an often-used technique to augment populations or remove animals from harm's way. Unfortunately, many translocation efforts fail to meet their goals for myriad reasons, particularly because translocated animals make large, erratic movements after release, which can result in high mortality rates. Soft release, holding animals in acclimation pens for some period of time at the recipient site before release, has been proposed as a technique to reduce these large movements and increase the survival of translocated animals. Here, we compared the survival and movement patterns of soft-released Texas horned lizards (Phrynosoma cornutum) with resident lizards, as well as hard-released lizards from a prior study. Juvenile lizards that were soft-released had high survival rates similar to resident lizards, despite still moving more frequently and occupying larger home ranges than residents. Conversely, soft-released adult lizards had survival rates similar to those that were hard-released, and much lower rates than resident adults. Curiously, soft-released adults did not have significantly higher movement rates or home range sizes than residents. Our results suggest that caution should be used before adult Texas horned lizards are translocated. However, juveniles responded well to soft release, and future research should explore whether they are more resilient to translocation in general, or if soft release provided a specific survival advantage. Contrary to our predictions, the survival of translocated animals was not related to their post-release movement patterns, and the mechanism underlying the observed survival patterns is unclear.

Houdini Tumor: Case Report and Literature Review of Pregnancy-Associated Meningioma.

BACKGROUND: Meningiomas are common intracranial neoplasms of undetermined etiology. Accelerated growth during episodes of elevated serum estrogen and progesterone have been demonstrated in pregnant patients, as exhibited by an overexpression of estrogen or progesterone on immunohistochemical analysis. This case report and literature review describe a case of complete meningioma regression in a postpartum patient. CASE DESCRIPTION: A 23-year-old female presented at 37 weeks of pregnancy with 1-month history of fluctuating severe left-sided headaches, periodic blurry vision, nausea, and vomiting. She had 2 previous pregnancies without complication. Magnetic resonance imaging revealed a dural-based, heterogeneously enhancing mass along the left tentorium, just posterior to the transverse sinus, with supratentorial extension and surrounding edema. Differential diagnoses included meningioma versus hemangioma versus hemangiopericytoma. The patient followed up with neurosurgery 1 month after delivery. She had continued left-sided headaches but no longer complained of visual changes. A postpartum surgical resection via left occipital and suboccipital craniotomy was planned. Approximately 1 month later (now about 3 months after delivery) a repeat magnetic resonance imaging demonstrated a marked decrease in meningioma size, and the previously seen edema had resolved. In light of the sudden disappearance of the meningioma, no further surgical intervention was pursued. CONCLUSIONS: Because meningioma shrinkage or disappearance may occur after pregnancy, repeat imaging is advised as part of a preoperative evaluation. In addition, it is possible that an undetermined amount of meningioma removal surgeries may be avoided with further research into monitoring hormone levels connected to meningioma growth.

Computed Tomography Cisternography for Evaluation of Trigeminal Neuralgia When Magnetic Resonance Imaging Is Contraindicated: Case Report and Review of the Literature.

BACKGROUND: Trigeminal neuralgia (TGN) causes severe unilateral facial pain. The etiology is hypothesized to be segmental demyelination of the trigeminal nerve root via compression by the superior cerebellar artery (SCA). Microvascular decompression (MVD) allows immediate and long-term pain relief. Preoperative evaluation includes magnetic resonance imaging (MRI) and/or magnetic resonance angiography of the brain. Having a pacemaker is a contraindication for MRI. There have been isolated reports of using computed tomography (CT) cisternography scans for radiation planning for TGN. CASE DESCRIPTION: A 75-year-old male with a permanent pacemaker who had refractory TGN in the V2 (maxillary) distribution of the trigeminal nerve underwent CT cisternography to prepare for MVD. CT angiography with Isovue 370 intravenous contrast injection and 0.625-mm axial images were obtained from the skull base across the posterior fossa. An intrathecal injection of Isovue 180 was performed at the L2/3 level. Imaging revealed the right SCA abutting the medial margin of the proximal right trigeminal nerve. In surgery (K.D.), a standard retrosigmoid suboccipital craniotomy was performed to access the cerebellopontine angle and separate the abutting SCA and trigeminal nerve. The patient had immediate pain relief. CONCLUSIONS: MRI is the preferred method of evaluating for TGN because it offers excellent visualization of vasculature in relation to the trigeminal nerve without accompanying radiation exposure. However, for patients who have contraindications to MRI, CT cisternography is shown to also be an effective method for visualizing the trigeminal root entry zone and nearby vasculature in preparation for MVD of the trigeminal nerve.