Adamantinoma: A review of the current literature.

Adamantinoma is a rare primary low-grade malignant tumour of the appendicular skeleton most commonly found in the tibia. It has an indolent course, with local recurrences and lung metastases occurring over a protracted duration. There have been several suggestions pertaining to a vascular origin in the literature, however, histogenesis remains unclear. Currently, guidelines are not available pertaining to clinical management. This paper presents an overview of the current literature regarding this unusual malignancy. It also explores disease etiology and acknowledges the benefits and challenges of investigations pertaining to diagnosis. It recognizes a paucity of recommendations regarding appropriate surveillance and follow up. This review aims to assist clinicians in the building of a consensus opinion for optimal adamantinoma case management under current circumstances where formal guidelines do not exist.

Effect of body mass index on shifts in ultrasound-based image-guided intensity-modulated radiation therapy for abdominal malignancies.

BACKGROUND AND PURPOSE: We investigated whether corrective shifts determined by daily ultrasound-based image-guidance correlate with body mass index (BMI) of patients treated with image-guided intensity-modulated radiation therapy (IG-IMRT) for abdominal malignancies. The utility of daily image-guidance, particularly for patients with BMI>25.0, is examined. MATERIALS AND METHODS: Total 3162 ultrasound-directed shifts were performed in 86 patients. Direction and magnitude of shifts were correlated with pretreatment BMI. Bivariate statistical analysis and analysis of set-up correction data were performed using systematic and random error calculations. RESULTS: Total 2040 daily alignments were performed. Average 3D vector of set-up correction for all patients was 12.1mm/fraction. Directional and absolute shifts and 3D vector length were significantly different between BMI cohorts. 3D displacement averaged 4.9 mm/fraction and 6.8mm/fraction for BMI < or = 25.0 and BMI>25.0, respectively. Systematic error in all axes and 3D vector was significantly greater for BMI>25.0. Differences in random error were not statistically significant. CONCLUSIONS: Set-up corrections derived from daily ultrasound-based IG-IMRT of abdominal tumors correlated with BMI. Daily image-guidance may improve precision of IMRT delivery with benefits assessed for the entire population, particularly patients with increased habitus. Requisite PTV margins suggested in the absence of daily image-guidance are significantly greater in patients with BMI>25.0.

Ciguatera fish poisoning with elevated muscle enzymes and abnormal spinal MRI.

We report three cases of ciguatera fish poisoning. One patient died secondary to respiratory failure. Two patients showed elevated muscle enzymes and one patients had an abnormal cervical spinal MRI. MRI findings have not been previously described. MRI findings explain the mechanism of the L'hermitte phenomenon (a common complaint) among these patients. Respiratory failure is rare in ciguatera fish poisoning. Our findings suggest this could be related to respiratory muscles involvement.

Acute mediastinal widening.

Mediastinal abscess resulting from descending necrotizing mediastinitis is a rare infectious process. Odontogenic infections are the most commonly implicated underlying process. Descending necrotizing mediastinitis is a rapidly progressive infectious process that spreads through the fascial planes of the neck to gain access to the mediastinum. Early recognition of descending necrotizing mediastinitis is important because the reported mortality rate is 30% to 50% even in the antibiotic era. Clues to the diagnosis of descending necrotizing mediastinitis include evidence of severe oropharyngeal infection, neck swelling and crepitations, and complaints of dysphagia and odynophagia. Lateral radiographs of the neck sometimes show gas pockets, but chest films are often negative early in the disease process. A late chest x-ray finding is widening of the superior mediastinum. Therefore, computed tomography (CT) is the imaging procedure of choice. Optimal treatment includes adequate drainage of the neck and mediastinum and broad spectrum intravenous antibiotics. Commonly implicated organisms are alpha-hemolytic streptococci and Bacteroides fragilis.