Management of iliofemoral deep vein thrombosis with distal involvement.

Endovascular treatment of iliofemoral deep vein thrombosis (IF DVT) can become more complex when thrombus extends below the knee. This article discusses various techniques that can be used to treat IF DVT with distal involvement.

Sharing images on social media without patient consent.

The purpose of this article is to initiate a discussion around the growing trend of sharing images of patients' scans without their consent on social media. While there are certainly merits in sharing images on social media, if undertaken without due care, it has the potential to be unprofessional and harmful to both patients and the radiology profession. In this article, I will outline some of the positive and negative aspects of sharing radiological images on social media, as well as some proposed solutions to help improve this practice.

Image-based computer modeling assessment of microwave ablation for treatment of adrenal tumors.

PURPOSE: To assess the feasibility of delivering microwave ablation for targeted treatment of aldosterone producing adenomas using image-based computational models. METHODS: We curated an anonymized dataset of diagnostic 11C-metomidate PET/CT images of 14 patients with aldosterone producing adenomas (APA). A semi-automated approach was developed to segment the APA, adrenal gland, and adjacent organs within 2 cm of the APA boundary. The segmented volumes were used to implement patient-specific 3D electromagnetic-bioheat transfer models of microwave ablation with a 2.45 GHz directional microwave ablation applicator. Ablation profiles were quantitatively assessed based on the extent of the APA target encompassed by an ablative thermal dose, while limiting thermal damage to the adjacent normal adrenal tissue and sensitive critical structures. RESULTS: Across the 14 patients, adrenal tumor volumes ranged between 393 mm3 and 2,395 mm3. On average, 70% of the adrenal tumor volumes received an ablative thermal dose of 240CEM43, while limiting thermal damage to non-target structures, and thermally sparing 83.5-96.4% of normal adrenal gland. Average ablation duration was 293 s (range: 60-600 s). Simulations indicated coverage of the APA with an ablative dose was limited when the axis of the ablation applicator was not well aligned with the major axis of the targeted APA. CONCLUSIONS: Image-based computational models demonstrate the potential for delivering microwave ablation to APA targets within the adrenal gland, while limiting thermal damage to surrounding non-target structures.

Pneumocephalus and Meningitis as Complications of Mastoiditis.

Pneumocephalus in the absence of trauma, tumour, or surgery is a rare entity. We report a case of a 73-year-old lady who presented with sepsis leading to confusion and unresponsiveness. A CT of brain revealed mastoiditis, sinusitis, and associated pneumocephalus. Further investigations led to an eventual diagnosis of pneumococcal meningitis. The combination of pneumocephalus and meningitis as complications of mastoiditis is rare with very few cases published in the literature. We describe one such case.

First Safety and Performance Evaluation of T45K, a Self-Assembling Peptide Barrier Hemostatic Device, After Skin Lesion Excision.

BACKGROUND: The self-assembling peptide barrier T45K (SAPB-T45K) is an oligopeptide that rapidly forms a biocompatible hemostatic barrier when applied to wounds. OBJECTIVE: Evaluate safety and performance of SAPB-T45K in cutaneous surgery. MATERIALS AND METHODS: In this single-blind study, after sequential shave excision of 2 lesions, wounds were randomized (intrapatient) to SAPB-T45K or control treatment. Safety was assessed at treatment, Day 7, and Day 30. Performance was evaluated using time to hemostasis (TTH) and ASEPSIS wound scores, with a subgroup analysis for patients with or without antiplatelet therapy. RESULTS: Each of 46 patients (10 [22%] with antiplatelet therapy) received randomized SAPB-T45K or control treatment for 2 wounds. Safety assessments were similar, and ASEPSIS scores reflected normal healing in both wound groups. SAPB-T45K demonstrated significantly faster median TTH (24.5 [range, 7-165] seconds) compared with control (44 [10-387] seconds), for a 41% median TTH reduction (18 [95% confidence interval, 7-35] seconds, p < .001). SAPB-T45K provided an identical median TTH of 24 seconds, regardless of antiplatelet therapy. Control median TTH was 90 and 40 seconds for patients taking or not taking antiplatelet therapy, respectively. CONCLUSIONS: SAPB-T45K provided significantly faster median TTH versus control, especially with antiplatelet therapy, and safety profiles were similar.

The diagnostic accuracy of ultrasonography for soft tissue lipomas: a systematic review.

BACKGROUND: Ultrasound has been used in the diagnosis of soft-tissue lesions for well over a decade. Lipomas are the most common, benign, soft-tissue tumor and comprise adipose tissue. The sensitivity and specificity of diagnosing lipomas on ultrasound vary greatly in the literature. PURPOSE: To perform a systematic review on ultrasonography in soft-tissue lipomas to better ascertain the true diagnostic value of this test. MATERIAL AND METHODS: A systematic review of the diagnostic value of ultrasound in lipomas was performed where possible in line with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. A comprehensive search of the literature was conducted using several well-known databases Scopus®, PubMed®, Ovid® Medline, and Web of Science®. RESULTS: A total of 455 articles were identified in the initial literature search. Six papers were included in the final systematic review, which revealed an overall sensitivity and specificity of 86.87% (95% confidence interval [CI] = 82.14-90.73) and 95.95% (95% CI = 93.75-97.54), respectively. CONCLUSION: Ultrasound is a useful tool in the diagnosis of superficial lipomas with good sensitivity and even better specificity and should continue to be the first line investigation in such cases.

Pyogenic Liver Abscess Following an Uncomplicated Colonoscopy.

Pyogenic liver abscess is a potentially devastating clinical entity associated with significant morbidity and mortality[1]. A myriad of causes for liver abscess have been described including intra-abdominal infections such as diverticulitis[2]. Due to a non-specific presentation, clinicians often require a high level of suspicion in their diagnosis of this condition. A handful of cases of liver abscess have been described following colonoscopy which was usually a complicated procedure or one where multiple biopsies had been taken[3,4]. The case of a patient presenting pyrexia of unknown origin one week after undergoing an uncomplicated colonoscopy in which no biopsies were taken is reported. She was ultimately diagnosed with a pyogenic liver abscess. LEARNING POINTS: Pyogenic liver abscess is an important differential when investigating pyrexia of unknown origin.Liver abscesses can rarely occur following colonoscopy.

Dupuytren's Contracture: A Bibliometric Study of the Most Cited Papers.

The literature on Dupuytren's contracture is vast yet little information is known as to which papers have been the most influential. The purpose of this study was to identify the 50 most cited papers on Dupuytren's contracture and perform a citation analysis. Utilizing the Web of Science, 23 surgical, medical, plastic and hand surgery journals were searched for papers on Dupuytren's contracture. Resulting articles were ranked in order of times cited and each paper was analyzed for article-type, year of publication, country of origin, institution and level of evidence. The 50 most cited articles represent many important landmarks in Dupuytren's treatment and contain several seminal works by experts in the field. Whilst the top 50 list highlights the important papers on the condition, they certainly do not provide information about the quality of the evidence of the research, as most papers presented level 4 or 5 evidence.

Fat grafting: a citation analysis of the seminal articles.

BACKGROUND: There has been substantial rise in the volume of published works on fat transfer in the medical literature in the past 25 years, and this is indicative of its growing popularity. However, many unanswered questions remain, and there is no consensus as to the optimum technique. Consequently, the scientific and clinical research on fat grafting continues to increase rapidly. The purpose of our study was to perform a bibliometric analysis of the most-cited articles in fat transfer. METHODS: Through the Web of Science, all articles relating to fat grafting were identified in the plastic and reconstructive literature. The 100 most-cited articles were identified and analyzed individually. RESULTS: Total citations ranged from 35 to 363 and the most-cited paper by Sidney Coleman was published in Plastic and Reconstructive Surgery. The United States produced 46% of the most-cited papers, and the University of California was the most prolific institution. Twenty-one articles focused on lipofilling to the face while 14 articles looked at fat grafting to the breast. CONCLUSIONS: The scientific relevance of a published work is reflected in the number of citations from peers that it receives. Therefore, the 100 most-cited papers in fat grafting have been the most influential articles on this field, and they are likely to be the ones that are remembered most.