Vascular malformation of the sphenoid and temporal bone: A diagnostic dilemma.

We present a rare case of a vascular anomaly of the sphenoid and temporal bones causing an expandable mass of the temporal region with dependent patient positioning and characteristic osseous changes on imaging. Initial diagnosis considerations included multiple myeloma (MM), fibrous dysplasia (FD), Paget's disease, lymphoma, meningoencephalocele (MEC), and vascular malformation (VaM). VaMs of the head and neck are rare and typically arise in the mandible and maxilla. However, this case demonstrates a unique finding of a VaM of the sphenoid and temporal bones with important radiological features to distinguish the diagnosis of vascular anomaly from other etiologies.

Demographic and socioeconomic factors predictive of compliance with American Thyroid Association guidelines for the treatment for advanced papillary thyroid carcinoma.

BACKGROUND: The American Thyroid Association (ATA) publishes evidence-based guidelines for the treatment of papillary thyroid carcinoma (PTC). We sought to identify factors associated with receiving treatment compliant with the 2006 ATA guidelines for advanced-stage PTC. METHODS: The 2006 ATA guideline compliance was examined in patients with stage III and IV PTC extrapolated from Surveillance, Epidemiology, and End Results (SEER). RESULTS: Sixty percent of patients received ATA-compliant treatment. A stepwise increase in compliance occurred between 2006 and 2009 (p-value trend = .0003). Age 45 to 64 years versus ≥65 (odds ratio [OR] = 0.682; 95% confidence interval [CI] = 0.57-0.81; p < .0001) and higher income (p trend = .012) were associated with an increased likelihood of receiving ATA-compliant care. African Americans (OR = 0.56; 95% CI = 0.42-0.76; p = .0001) and single patients (OR = 0.81; 95% CI = 0.67-0.97; p = .02) were less likely to receive ATA-compliant care. CONCLUSION: This study highlights specific populations at risk for receiving non-ATA-compliant care for PTC and underscores the need to further implement guideline-based practice.

Pediatric ventricular assist device use as a bridge to transplantation does not affect long-term quality of life.

OBJECTIVE: The present study sought to determine the long-term quality of life (QOL) of children who required long-term ventricular assist device (VAD) support as a bridge to transplantation (BTT) compared with children who underwent heart transplantation without VAD support. Currently, 20% of children undergoing heart transplantation have required a VAD as a BTT. Few data have been published assessing how children requiring a VAD as a BTT will fair in terms of their long-term QOL. METHODS: The present study used a cross-sectional design, using the Core and Cardiac modules of the Pediatric Quality of Life Inventory survey. In a secondary analysis, the factors associated with worse QOL outcomes among the VAD patients were also investigated. RESULTS: At follow-up (median, 4.2 years), between the 21 children who required a VAD as a BTT and 42 who went straight to transplantation, no significant differences were found in the QOL as measured using the Psychosocial Health Summary Score, Physical Health Summary Score, or Total Score in the survey's Core Module, nor were any differences found in the outcomes assessed using the survey's Cardiac Module. Of the patients who required a VAD, only the presence of a neurologic complication was associated with worse QOL, which was demonstrated by decreased Physical Health Summary and Cardiac Communication scores. CONCLUSIONS: Over the long term, surviving children who required a long-term VAD as a BTT experience a similar QOL as those who went straight to transplantation.