Shimming with permanent magnets for the x-ray detector in a hybrid x-ray/ MR system.

In this x-ray/MR hybrid system an x-ray flat panel detector is placed under the patient cradle, close to the MR volume of interest (VOI), where the magnetic field strength is approximately 0.5 T. Immersed in this strong field, several electronic components inside the detector become magnetized and create an additional magnetic field that is superimposed on the original field of the MR scanner. Even after linear shimming, the field homogeneity of the MR scanner remains disrupted by the detector. The authors characterize the field due to the detector with the field of two magnetic dipoles and further show that two sets of permanent magnets (NdFeB) can withstand the main magnetic field and compensate for the nonlinear components of the additional field. The ideal number of magnets and their locations are calculated based on a field map measured with the detector in place. Experimental results demonstrate great promise for this technique, which may be useful in many settings where devices with magnetic components need to be placed inside or close to an MR scanner.

Postchemoembolization liver abscess: findings on hepatobiliary scintigraphy.

We describe a 41-year-old man with a 1-week history of nausea and vomiting 1 month after chemoembolization of a liver metastasis. The patient subsequently became febrile and developed right upper quadrant abdominal and midback pain. Findings of initial laboratory and imaging studies (a noncontrast computed tomographic [CT] scan and ultrasound) were not remarkable. Hepatobiliary scintigraphy, performed to rule out cholecystitis, revealed an abnormal area in the right lobe of the liver consistent with a focal bile leak into an abscess cavity. The patient was subsequently treated for liver abscess. In conclusion, hepatobiliary scintigraphy should be considered as a first-line test in the work-up of patients whenever a postchemoembolization complication is considered likely.

Developing the discipline and practice of comprehensive men's health.

Men of all ages in the United States experience disproportionately higher rates of morbidity and premature death than females. The reasons for this are complex and include biological, sociological, and health system-related issues, but this is also in part due to the fact that men and boys tend to lead more risky lifestyles and generally avoid preventive care when compared with women and girls. These disparities not only affect males but also their loved ones and can adversely affect their participation in the workforce and in their communities. Better understanding of the drivers of men's health disparities is needed to enable health professionals to more effectively address this problem. One of the fundamental building blocks for changing health care delivery to males is to provide a core curricular framework for education and training of health professionals related to the specific health issues of men and boys. This article will present a study assessing what men's health courses are available in the United States and identifying the content within such courses that will prepare health care professionals to deliver programs and care to this demographic. The study identified that as of 2012, there were only 21 courses in 18 institutions that address gender-appropriate health care for boys and men. The authors conclude that developing and incorporating an expert, consensus-based men's health core curriculum in universities and colleges, particularly in health professional programs, is an extremely important cornerstone in advancing the science and practice of true and balanced gender-based care delivery.

The economic burden shouldered by public and private entities as a consequence of health disparities between men and women.

On average, American men live shorter, less healthy lives than women. They are more likely to be the victim of a violent crime, die in a car crash, commit suicide, and be injured at work. In addition, men have higher death rates in 9 of the top 10 causes of death, and are less likely to receive routine preventative care, leaving men with a life span that is significantly shorter than women's. Recently, policy makers and researchers have been paying more attention to health disparities including race, sex, and ethnicity. However, men are still noticeably absent from these discussions despite being significantly harmed by disparities in preventive care, quality of life, and overall health outcomes. Ignoring these disparities is costly in terms of lost productivity, lives lost, and financial costs incurred by the government and employers each year. Premature death and morbidity in men costs federal, state, and local governments in excess of $142 billion annually. It also costs U.S.employers and society as a whole in excess of $156 billion annually in direct medical payments and lost productivity and an additional $181 billion annually in decreased quality of life. As federal and state governments and the private sector struggle with increasing health entitlement burdens-including escalating health care costs-eliminating male health inequities emerges as an important source of savings. This analysis will examine the economic and intangible costs associated with the health disparities that exist between genders and the benefits reaped if these disparities are reduced or eliminated.

Durable complete response of refractory, progressing metastatic melanoma after treatment with a patient-specific vaccine.

A patient with metastatic melanoma who experienced a durable complete response after treatment with a patient-specific vaccine has been described in this article. This 59-year-old woman presented with cervical spine metastases and, within the year, had experienced local disease progression and, despite various therapies, metastases to the axilla, rectum, gall bladder, and multiple soft-tissue sites. She had previously received radiation therapy, combination chemotherapy, interleukin-2 plus interferon biotherapy, and gamma knife radiosurgery, and undergone multiple surgical resections. At the time vaccine therapy was initiated, she had multiple, new, measurable, soft-tissue metastases that were increasing in size. She was treated with a vaccine consisting of autologous dendritic cells incubated with irradiated tumor cells from an autologous tumor cell line and suspended in granulocyte-macrophage colony stimulating factor (GM-CSF), with subcutaneous injections once a week for 3 weeks and monthly for 5 months. There was evidence of disease regression by the completion of therapy. A few months later a complete response was documented by radiologic scans, and subsequently reconfirmed at 6-month intervals. She remains in complete remission >2.5 years after starting the vaccine, and >2 years after completing the vaccine, and survives >4 years after her initial presentation with bone, bowel, and lymph node metastases. This is the first time she has been in a complete remission since her initial diagnosis. Patient-specific vaccines can sometimes induce durable complete regression of progressing soft-tissue melanoma metastases.