Quantitative and qualitative assessment of a coding system for reporting CT colonography.

AIM: To validate a coding system implemented to summarise computed tomography colonography (CTC) findings for the detection of suspected colorectal cancer (CRC) by assessing interobserver variability and also to evaluate any weaknesses through qualitative analysis. MATERIALS AND METHODS: All CTC investigations over a 6-month period (01/07/2016 to 31/12/2016) were analysed retrospectively. Each study was read initially by an advanced practitioner radiographer with a final report issued by a consultant gastrointestinal radiologist. Rates of interobserver agreement, using the kappa statistic, provided a quantitative assessment of levels of agreement. Areas of poor interobserver agreement were identified for further qualitative assessment. RESULTS: The present study included 1,321 CTC procedures and the mean age of patients was 68.4 years (range 28-96 years). Percentage agreement for colonic coding was 90% and for extra-colonic coding 47%. This corresponds to kappa scores of 0.69 (substantial agreement) and 0.22 (fair agreement), respectively. Reasons and examples of disagreement in the colonic coding are highlighted. CONCLUSIONS: High interobserver agreement was observed for C coding, suggesting it is a reproducible method of classifying intra-colonic CTC findings. Some of the difference in classifying extra-colonic findings is the perceived importance of incidental findings between readers, as well as differences in skill set; however, some themes recurred in areas of disagreement and recommendations for refining and improving the coding system are provided.

T-cell bispecific antibodies in node-positive breast cancer: novel therapeutic avenue for MHC class I loss variants.

BACKGROUND: Tumor-infiltrating lymphocytes (TILs) represent a prognostic factor for survival in primary breast cancer (BC). Nonetheless, neoepitope load and TILs cytolytic activity are modest in BC, compromising the efficacy of immune-activating antibodies, which do not yet compete against immunogenic chemotherapy. PATIENTS AND METHODS: We analyzed by functional flow cytometry the immune dynamics of primary and metastatic axillary nodes [metastatic lymph nodes (mLN)] in early BC (EBC) after exposure to T-cell bispecific antibodies (TCB) bridging CD3ε and human epidermal growth factor receptor 2 (HER2) or Carcinoembryonic Antigen-Related Cell Adhesion Molecule 5 (CEACAM5), before and after chemotherapy. Human leukocyte antigen (HLA) class I loss was assessed by whole exome sequencing and immunohistochemistry. One hundred primary BC, 64 surrounding 'healthy tissue' and 24 mLN-related parameters were analyzed. RESULTS: HLA loss of heterozygosity was observed in EBC, at a clonal and subclonal level and was associated with regulatory T cells and T-cell immunoglobulin and mucin-domain-3 expression restraining the immuno-stimulatory effects of neoadjuvant chemotherapy. TCB bridging CD3ε and HER2 or CEACAM5 could bypass major histocompatibility complex (MHC) class I loss, partially rescuing T-cell functions in mLN. CONCLUSION: TCB should be developed in BC to circumvent low MHC/peptide complexes.

Vortex gyroscope imaging of planar superfluids.

We propose a robust imaging technique that makes it possible to distinguish vortices from antivortices in quasi-two-dimensional Bose-Einstein condensates from a single image of the density of the atoms. Tilting the planar condensate prior to standard absorption imaging excites a generalized gyroscopic mode of the condensate, revealing the sign and location of each vortex. This technique is anticipated to enable experimental measurement of the incompressible kinetic energy spectrum of the condensate and the observation of a negative-temperature phase transition of the vortex gas, driven by two-dimensional superfluid turbulence.

Phytobezoar: a rare cause of late upper gastrointestinal perforation following gastric bypass surgery.

Marginal ulcers are a well described complication following Roux-en-Y gastric bypass. These may be a cause for perforation. We describe a case of upper gastrointestinal perforation 18 months following a laparoscopic Roux-en-Y gastric bypass that appeared to be caused by a food bezoar. The perforation occurred at the site of the jejunojejunal anastomosis and was repaired after an exploratory laparotomy. After extracting the food debris (phytobezoar) through the perforation, direct closure resulted in an uneventful post-operative recovery. To our knowledge, this is the first description of a food bezoar causing an intestinal perforation in such a manor after bariatric surgery. Patients should be educated carefully on what and how to eat after having undergone surgery for superobesity.

Management of febrile neutropenia in an acute oncology service.

BACKGROUND: Neutropenic fever in patients receiving chemotherapy is a medical emergency and should be treated promptly within 1 h with antibiotics as specified within the 2009 NCAG report on chemotherapy services. AIM: To determine door-to-assessment, door-to-treatment and door-to-investigation intervals for patients with febrile neutropenia who presented to the inpatient Oncology Ward, the outpatient Oncology Day Unit and the Emergency Department in Addenbrooke's Hospital, Cambridge. DESIGN: Retrospective observational audit. METHODS: Thirty-two patients on treatment for solid cancers who were admitted with febrile neutropenia between January and December 2010 were identified, and paper and electronic medical records were analysed to determine door to: assessment, treatment and investigation intervals. RESULTS AND CONCLUSIONS: Patients in this series were assessed quicker and received the first dose of antibiotics faster when they presented to an oncology ward rather than the emergency department. However, imaging was performed faster and blood results issued quicker if performed in the emergency department due to a better infrastructure that has been tailored to comply with national targets. Nonetheless, compliance with optimum standards of care was poor, with only 9% of sampled patients getting antibiotics within 1 h of presenting to hospital, and 53% within 1 h of being assessed by a clinician.

Frostbite following use of a commercially available cryotherapy device for the removal of viral warts.

Warts are a common skin complaint in childhood. We describe 3 unusual cases in which inadvertent tissue injury was caused during the treatment of viral warts by a commercially available cryotherapy device. In each case there was a failure to follow the instructions provided correctly. If such devices are to remain available for public use we feel changes should be implemented to reduce the risk of such injuries occurring again in the future. Alternatively, cryotherapy as a treatment modality should remain in the realm of the trained health care professional.

Relief of severe retro-orbital pain and vision improvement after optic-nerve decompression in polyostotic fibrous dysplasia: case report and review of the literature.

INTRODUCTION: We describe a case of a 9-year-old girl who developed progressive severe retro-orbital pain and partial visual loss in association with left optic-nerve compression due to polyostotic fibrous dysplasia of the skull. MATERIALS AND METHODS: Intradural decompression of the optic nerve resulted in immediate and complete resolution of the pain as well as a vast visual improvement. CONCLUSION: In cases of fibrous dysplasia of the skull with evidence of optic-nerve compression, relief of retro-orbital pain should be an additional consideration when deciding to proceed with surgical management.