Cerebral Venous Thrombosis in the Setting of Malignancy: Case Report and Review of the Literature.

Cerebral venous thrombosis (CVT) is a rare condition that can be difficult to diagnose due to its vague and nonspecific symptoms. It is even more unusual to identify CVT in association with malignancy. Given the rarity of this disease, treatment and management of CVT in the setting of malignancy is not well defined. This case report and review of the literature addresses the epidemiology, pathophysiology, and medical treatment for malignancy-related CVT.

A comparison of ferumoxytol with gadolinium as contrast agents for the diagnostic magnetic resonance imaging of osteomyelitis.

BACKGROUND: Ferumoxytol, an FDA-approved superparamagnetic iron oxide nanoparticle (SPION) preparation used for the treatment of iron deficiency anemia, is also known to be taken up by macrophages in areas of infection or inflammation, where it produces negative contrast changes on T2-weighted MR images. PURPOSE: We sought to compare Ferumoxytol-induced MRI contrast changes with those observed using standard-of-care Gadolinium in patients presenting with symptoms suggestive of osteomyelitis. SUBJECTS: Out of eighteen enrolled patients, 15 had MR imaging with both ferumoxytol and gadolinium. Based on clinical and/or pathologic criteria, 7 patients were diagnosed with osteomyelitis, 5 patients had osteomyelitis ruled out, and in 3 patients a definitive diagnosis could not be made. FIELD STRENGTH: 1.5 Tesla. SEQUENCES: Used included STIR, T1-weighted and T2-weighted spin echo. ASSESSMENT: The mean contrast changes upon ferumoxytol and gadolinium administration were measured from lesion regions of interest and compared with control regions. STATISTICAL TESTS: Student's t-test, propagation of errors. Data are reported as means ± S.E. RESULTS: The mean contrast changes, ΔC, associated with a diagnosis of osteomyelitis were found to be ΔCFe = -2.7 ± 0.7 when Ferumoxytol and T2w imaging sequences were used and ΔCGd = +3.1 ± 1.1 (P < 0.001) when Gadolinium and a T1w imaging sequence was used. The MRI contrast changes for both agents correlated with systemic markers of inflammation, such as the erythrocyte sedimentation rate. In patients without osteomyelitis, no significant contrast changes were observed in T2-weighted, Ferumoxytol-contrasted MRI. The macrophages in osteomyelitic lesions were found to take up at least 16 times as much iron as benign bone marrow. DATA CONCLUSION: We conclude that in terms of its MRI diagnostic accuracy for osteomyelitis Ferumoxytol-contrasted MRI is a promising approach for diagnosing osteomyelitis that merits further study.

Effective and Ineffective Clinical Teaching in Dental Hygiene Education: A Qualitative Study.

Clinical instructors play a significant role in student learning in dental hygiene education, but more information is needed on which instructor characteristics best promote student development. The aim of this study was to identify clinical dental hygiene instructor traits that are effective and ineffective for student learning as defined by dental hygiene students and instructors. A qualitative study using grounded theory and critical incident technique was conducted to investigate junior students', senior students', and instructors' perceptions in one U.S. dental hygiene program in 2014. The methods used were an open-ended electronic survey, one-on-one interviews, and focus groups. Qualities identified were coded and organized into categories and themes, then tabulated by importance by cohort. A total of 24 junior students, 22 senior students, and nine clinical faculty members participated in all three parts of the study. The surveys revealed 322 qualities and characteristics, and the interviews revealed 162, which were then coded into 26 and 23 categories of effective and ineffective traits, respectively. Three major themes of instructor characteristics emerged: affective, pedagogical, and expertise-related. Variances in the frequency of these themes were found between junior and senior students. Differences were also noted between students and instructors in terms of the importance of several characteristics. Specific effective teaching methods were also discovered in the interviews. In this study, multiple effective and ineffective dental hygiene clinical instructor characteristics were identified. These findings have implications for curriculum, instructor training, and evaluation and create a foundation for future research.

A difficult diagnosis: acute histoplasmosis.

A 43-year-old male with deceased donor kidney transplantation presented with fever of unknown etiology and underwent an extensive workup. The diagnosis of histoplasmosis was made after biopsy of a positron emission tomography-positive subcarinal lymph node showed non-caseating granulomas with a positive stain for yeast. The diagnosis was confirmed when fevers remitted with initiation of appropriate anti-fungal therapy.