A Vulvar Venous Malformation in a 14-Year-Old Adolescent.

A vulvar venous malformation is a rare condition that can be misdiagnosed as vulvar varicose veins, but they are not the same entity. We describe the case of a 14-year-old nulliparous girl who presented with pelvic discomfort and limited ambulation secondary to a small, purple vulvar mass. The diagnosis was confirmed with the use of invasive imaging techniques after initial conservative management. Clinicians should consider venous malformations in the differential diagnosis of vulvar swelling in adolescents, and an earlier use of phlebography in patients with discordance between workup and symptoms to ensure a prompt diagnosis and decreased patient morbidity.

Hybrid MRI-Ultrasound acquisitions, and scannerless real-time imaging.

PURPOSE: To combine MRI, ultrasound, and computer science methodologies toward generating MRI contrast at the high frame rates of ultrasound, inside and even outside the MRI bore. METHODS: A small transducer, held onto the abdomen with an adhesive bandage, collected ultrasound signals during MRI. Based on these ultrasound signals and their correlations with MRI, a machine-learning algorithm created synthetic MR images at frame rates up to 100 per second. In one particular implementation, volunteers were taken out of the MRI bore with the ultrasound sensor still in place, and MR images were generated on the basis of ultrasound signal and learned correlations alone in a "scannerless" manner. RESULTS: Hybrid ultrasound-MRI data were acquired in eight separate imaging sessions. Locations of liver features, in synthetic images, were compared with those from acquired images: The mean error was 1.0 pixel (2.1 mm), with best case 0.4 and worst case 4.1 pixels (in the presence of heavy coughing). For results from outside the bore, qualitative validation involved optically tracked ultrasound imaging with/without coughing. CONCLUSION: The proposed setup can generate an accurate stream of high-speed MR images, up to 100 frames per second, inside or even outside the MR bore. Magn Reson Med 78:897-908, 2017. © 2016 International Society for Magnetic Resonance in Medicine.

Pharmacodynamic stimulation of thrombogenesis by angiotensin (1-7) in recurrent ovarian cancer patients receiving gemcitabine and platinum-based chemotherapy.

PURPOSE: This randomized, double-blind, placebo-controlled Phase 2 study evaluated safety and efficacy of A(1-7) for reduction in Grade 3-4 thrombocytopenia in patients receiving myelosuppressive chemotherapy. Pharmacodynamic activity of A(1-7) in platelet production and retention of scheduled dose intensity were also determined. METHODS: Thirty-four patients with ovarian, Fallopian tube, or peritoneal carcinoma receiving gemcitabine and carboplatin or cisplatin were evaluated. Patients were randomized to receive study drug subcutaneously at 100 mcg/kg (n = 11), 300 mcg/kg (n = 13), or placebo (n = 10) following chemotherapy for up to six cycles. Hematologic variables were obtained throughout each treatment cycle. RESULTS: There were no drug-related safety issues. There were no instances of Grade 4 thrombocytopenia in patients who received 100 mcg/kg treatment compared to 6 % of chemotherapy cycles for patients receiving placebo (p = 0.07). The maximal percentage increase in platelet concentration from baseline was higher for patients who received 100 mcg/kg A(1-7) compared to placebo (p = 0.02). This increase was accompanied by a reduction in the nadir absolute neutrophil count (p = 0.04). Relative dose intensity for the combination chemotherapy was higher for patients who received 100 mcg/kg A(1-7) compared to placebo (p = 0.04). There were no differences in outcomes for patients receiving 300 mcg/kg dose compared to placebo. CONCLUSIONS: A 100 mcg/kg dose of A(1-7) was shown to produce pharmacodynamic effects on peripheral blood platelet counts, preserve planned dose intensity, and reduce Grade 3-4 thrombocytopenia following gemcitabine and platinum chemotherapy. These findings are consistent with A(1-7)-induced stimulation of thrombogenesis in the bone marrow following marrow-toxic chemotherapy.

Ultrasound echoes as biometric navigators.

We demonstrate a new method of using ultrasound data to achieve prospective motion compensation in MRI, especially for respiratory motion during interventional MRI procedures in moving organs such as the liver. The method relies on fingerprint-like biometrically distinct ultrasound echo patterns produced by different locations in tissue, which are collated with geometrical information from MRI during a training stage to form a mapping table that relates ultrasound measurements to positions. During prospective correction, the system makes frequent ultrasound measurements and uses the map to determine the corresponding position. Results in motorized linear motion phantoms and freely breathing animals indicate that the system performs well. Apparent motion is reduced by up to 97.8%, and motion artifacts are reduced or eliminated in two-dimensional spoiled gradient-echo images. The motion compensation is sufficient to permit MRI thermometry of focused ultrasound heating during respiratory-like motion, with results similar to those obtained in the absence of motion. This new technique may have applications for MRI thermometry and other dynamic imaging in the abdomen during free breathing.

Gemcitabine-induced radiation recall dermatitis following whole pelvic radiation therapy.

OBJECTIVES: Radiation recall dermatitis secondary to gemcitabine use has been reported in isolated cases of patients treated for breast and lung cancers. There have been no reports of radiation recall dermatitis from gemcitabine after whole pelvic radiation therapy employed as a treatment of a gynecologic cancer. CASE: A 67-year-old woman was treated with whole pelvic radiation for palliation of lower extremity swelling and pain due to recurrent ovarian adenocarcinoma. Three months later, the patient was treated with gemcitabine for three courses. Therapy was discontinued secondary to severe cellulitis and edema of the skin of the anterior abdominal wall in the field of her prior radiation therapy. CONCLUSIONS: Radiation recall dermatitis secondary to gemcitabine should be considered in any patient with pelvic or lower abdominal skin abnormalities after pelvic radiation and subsequent gemcitabine therapy.