A catalyst for transforming health systems and person-centred care: Canadian national position statement on patient-reported outcomes.

Background: Patient-reported outcomes (pros) are essential to capture the patient's perspective and to influence care. Although pros and pro measures are known to have many important benefits, they are not consistently being used and there is there no Canadian pros oversight. The Position Statement presented here is the first step toward supporting the implementation of pros in the Canadian health care setting. Methods: The Canadian pros National Steering Committee drafted position statements, which were submitted for stakeholder feedback before, during, and after the first National Canadian Patient Reported Outcomes (canpros) scientific conference, 14-15 November 2019 in Calgary, Alberta. In addition to the stakeholder feedback cycle, a patient advocate group submitted a section to capture the patient voice. Results: The canpros Position Statement is an outcome of the 2019 canpros scientific conference, with an oncology focus. The Position Statement is categorized into 6 sections covering 4 theme areas: Patient and Families, Health Policy, Clinical Implementation, and Research. The patient voice perfectly mirrors the recommendations that the experts reached by consensus and provides an overriding impetus for the use of pros in health care. Conclusions: Although our vision of pros transforming the health care system to be more patient-centred is still aspirational, the Position Statement presented here takes a first step toward providing recommendations in key areas to align Canadian efforts. The Position Statement is directed toward a health policy audience; future iterations will target other audiences, including researchers, clinicians, and patients. Our intent is that future versions will broaden the focus to include chronic diseases beyond cancer.

Menstrual cycle variation of apparent diffusion coefficients measured in the normal breast using MRI.

Recent investigations have shown that tumors may be distinguished from benign lesions in the breast based on differences in apparent diffusion coefficient (ADC) values. The goal of this study was to assess the magnitude of normal variations in the measured ADC of breast parenchyma during the menstrual cycle. Eight healthy female subjects were scanned once a week for 4 weeks, using a diffusion-weighted single-shot fast spin-echo (DW-SSFSE) sequence. The ADC of breast fibroglandular tissue was calculated for each woman at each time point. Results showed a trend of decreased ADC during the second week of the cycle, and increased ADC during the final week. However, no significant influence of menstrual cycle on breast ADC values was identified. The results of this study show that the normal fluctuation of breast ADC is relatively small, and the coefficient of variation was determined to be 5.5% for our group of volunteers during a menstrual cycle. Nonetheless, breast diffusion measurements for tumor differentiation and evaluation of treatment response should be interpreted with consideration of normal variability.

Cystadenomas of the liver: a spectrum of disease.

OBJECTIVES: To describe the wide variation in presentation of cystadenomas of the liver and to delineate useful tests for diagnosis and effective surgical treatment. DESIGN: A case series. SETTING: A university-affiliated hospital. PATIENTS: Four patients (3 women, 1 man) having cystadenoma of the liver, 2 of whom had associated mesenchymal stroma. MAIN OUTCOME MEASURES: Serum and cyst fluid carcinoembryonic antigen (CEA) and CA19-9 levels, type of surgery, morbidity and recurrence rates. RESULTS: Cyst fluid CEA and CA19-9 levels were elevated. One patient had resection, 2 had complete enucleation and 1 had partial enucleation. There were no deaths. Morbidity included 1 wound infection; there were no biliary fistulas. The patient with partial enucleation had a radiologically confirmed recurrence. CONCLUSIONS: Analysis of cyst fluid CEA and CA19-9 is useful for diagnosis; besides hepatic resection, complete enucleation should be considered as a reasonable treatment for patients with this disease.

Cystadenoma of the liver without mesenchymal stroma in a female following hormonal therapy for acne.

BACKGROUND: Liver cystadenomas are relatively rare tumours that can be difficult to diagnose; treatment entails complete surgical extirpation either by either anatomical resection or enucleation. CASE OUTLINE: A 19-year-old woman presented with acute onset of abdominal pain and was found to have a multilocular giant liver cyst.The cyst was percutaneously drained; CEA and CA 19-9 tumour markers were elevated in this cyst fluid: CEA 96 microg/L, CAI9-9 37 550 kU/L. The cyst was completely enucleated and has not recurred. Pathological examination confirmed a cystadenoma without mesenchymal stroma, and tumour oestrogen and progesterone receptors were negative. DISCUSSION: This is the fourth report of a liver cystadenoma without mesenchymal stroma in a female and the first to document elevated cyst fluid tumour markers. This case also illustrates the possible relationship between hormonal therapy and tumour growth.

Magnetic resonance imaging of benign spinal lesions simulating metastasis: role of diffusion-weighted imaging.

In an attempt to avoid unnecessary therapy, this article demonstrates benign vertebral body lesions that mimic metastatic disease in cancer patients with back pain. The magnetic resonance imaging features that aid in differential diagnosis are demonstrated. In addition, the value of diffusion-weighted spinal imaging to further aid in distinguishing benign from malignant disease is described.

Biopsy needle susceptibility artifacts.

Understanding the appearance of thin metallic structures in magnetic resonance imaging is important for evaluating the potential role of MRI in guiding and monitoring percutaneous interventions. As most MR compatible instruments are made from materials with a susceptibility different from water, their visibility is enhanced beyond what is expected on the grounds of displaced water alone. Unfortunately, this artifactually enhanced visibility is not constant, but instead depends on a variety of factors. This article presents computer simulations of the image distortion resulting from magnetic susceptibility differences between a needle and the surrounding tissue. The simulations show not only an artifact size that is dependent on needle composition, orientation, and pulse sequence, but also a corresponding shift of the artifact center away from the actual center of the needle. These effects place limits on the accuracy of MRI-guided needle tip placement.

Virtual MR angioscopy of the pulmonary artery tree.

An optimized, contrast-enhanced 3D MR angiography sequence is combined with image postprocessing to render interior views of the pulmonary arteries. Virtual angioscopy was successfully demonstrated on both a healthy volunteer and a pulmonary embolism patient. By targeting selected pulmonary artery branches, virtual angioscopy has the potential to become a powerful adjunct to the use of reformatted sections and maximum intensity projections in the assessment of pulmonary embolism.

CT of the liver after cryotherapy of hepatic metastases: imaging findings.

Cryotherapy is the in situ destruction of abnormal tissue using subzero temperatures (Fig. 1). Recent studies have demonstrated the technical feasibility, safety, and effectiveness of hepatic cryotherapy in the treatment of liver tumors [1, 2]. Such treatment can be precisely focused on the tumor, thereby preserving surrounding normal tissue. In addition, because major vessels with flowing blood are protected from cryoablation, tumors adjacent to these vessels can be treated without sacrificing vasculature. Hepatic cryoablation is therefore particularly suitable for patients who do not qualify for surgical resection because of multiple metastases involving both lobes of the liver, or because of lesions close to major blood vessels. After the procedure, CT during arterioportography is of little value in distinguishing cryolesion from malignant tumor (Fig. 2), and CT with IV contrast enhancement is recommended for follow-up. It is important to distinguish CT findings of successful and unsuccessful treatment, treatment complications such as abscess and cholestasis, and recurrent tumor. The purpose of this essay is to illustrate the findings on CT with IV contrast enhancement in various situations, emphasizing features that are useful in making accurate differential diagnosis.

Fast spin-echo inversion-recovery imaging versus fast T2-weighted spin-echo imaging in bone marrow abnormalities.

RATIONALE AND OBJECTIVES: The purpose of this investigation is to compare a fat-suppressed T2-weighted fast spin-echo (FSE) sequence in bone marrow abnormalities with an FSE STIR sequence that recently has become commercially available. METHODS: Fast spin-echo images (repetition time [TR], 3500-5000 mseconds; echo time [TE], 96-114 mseconds) and FSE STIR images (TR, 3000-5000 mseconds; TE, 32-40 mseconds; inversion time [TI], 140-150 mseconds) were compared quantitatively and qualitatively calculating signal-to-noise ratios (SNRs), contrast-to-noise ratios (CNRs), and lesion conspicuity and using a qualitative scoring system. RESULTS: Signal-to-noise ratio (mean +/- standard deviation) was 36.4 +/- 19.3 for the FSE and 29.0 +/- 15.9 for the FSE STIR images (P = .002). Contrast-to-noise ratio (mean +/- standard deviation) was 18.7 +/- 14.3 for the FSE and 20.3 +/- 16.0 for the FSE STIR images (P = .45). Lesion conspicuity (mean +/- standard deviation) was 1.7 +/- 1.5 for the FSE and 3.5 +/- 4.0 for the FSE STIR images (P = .025). The most important difference in the qualitative evaluation related to the better signal homogeneity on the FSE STIR images. CONCLUSIONS: Fast spin-echo STIR images may be preferable to FSE images with fat suppression due to better image homogeneity and lesion conspicuity.

Gas chromatographic assay of vigabatrin enantiomers in plasma.

A rapid and specific gas chromatographic method has been developed for the determination of plasma R(-)- and S(+)-vigabatrin concentrations. The method involves a double derivatisation step, chromatography on a megabore Chirasil-Val capillary column and thermionic specific detection. Concentrations in the range 1.0-200 micrograms/ml can be measured for R(-)-vigabatrin, and 0.5-100 micrograms/ml for S(+)-vigabatrin, using 250 microliters of plasma. The assay is suitable for pharmacokinetic studies and routine therapeutic drug monitoring in humans.

The influence of other anticonvulsants on the plasma concentration of E-2-en-valproate.

E-2-en-valproate is a major metabolite present in the blood of humans treated with valproate. In animals it is a potent anticonvulsant. We have measured concentrations of valproate and E-2-en-valproate in 102 plasma samples obtained from 75 adult patients (20 taking valproate only; 55 taking valproate and other anticonvulsants) under steady-state conditions. The two groups' mean ages and weights were comparable. The average valproate daily dose was lower (p < 0.002) in the monotherapy group (1152 +/- S.D. 661 mg/d) than in the polypharmacy group (1902 +/- S.D. 874 mg/d). Despite this, the mean plasma levels of valproate and E-2-en-valproate were significantly higher (p < 0.05, p < 0.0001, respectively) in the monotherapy group (60.0 +/- S.D. 22.6 micrograms/ml; 3.00 +/- S.D. 1.40 micrograms/ml, respectively) than in the polypharmacy group (49.5 +/- S.D. 24.8 micrograms/ml; 1.73 +/- S.D. 0.95 microgram/ml). While the mean plasma valproate level was 17.5% lower in the polypharmacy group, the mean plasma E-2-en-valproate level was 42% lower. The co-administration of other anticonvulsants significantly reduced the concentration of valproate and, more so, of E-2-en-valproate in plasma.

A cytotoxic T-lymphocyte clone derived from mice with progressively growing tumors.

Tumor-specific T-cell clones were derived from spleen cells of mice bearing a syngeneic PHS-5 tumor (a P815 mastocytoma mutant). Cells were expanded in vitro and characterized and assayed for activity against the relevant tumor in vivo. Clone cells were CD4-, CD8+ T lymphocytes, as determined by fluorescence activated cell sorting analysis and were specifically cytotoxic against P815 tumor cells in vitro, as shown in chromium 51 release assays. These cells require both antigen and interleukin 2 to proliferate; neither alone is sufficient, even with the addition of interleukin 1. In an experimental P815 liver metastasis model, the adoptive transfer of GD11 or GD11.17 clone cells and injection of recombinant interleukin 2 (7500 U intraperitoneally) 3 days after infusion of tumor cells reduced the number of tumor nodules, while the adoptive transfer of lymphokine-activated killer cells was ineffective.