CT-Guided Percutaneous Laser Disc Decompression for Lumbar Discogenic Radiculopathy-Performance of a Novel Combi-Therapy.

BACKGROUND AND OBJECTIVES: On the basis of reported immediate and short-term excruciating pain by patients in the post-procedural period of computed tomography (CT)-guided percutaneous laser disc decompression (PLDD) in our clinic, we present our initial clinical experience with a novel combi-therapy using a combination of CT-guided PLDD and CT-guided epidural nerve blocks, which proved effective in managing the pain. STUDY DESIGN/MATERIALS AND METHODS: A total of 100 patients who met the criteria for PLDD, underwent treatment for lumbar discogenic radiculopathy between 2014 and 2017. Fifty-five percent of the patients were males and 45% were females with a mean age of 46.25 years. Ninety-five patients underwent one level PLDD and five patients two-level PLDD procedures. CT-guided epidural nerve block with a combination of Bupivacaine, Lignocaine, and Kenalog was used in a 3× procedure separated by a 1-week interval. The first nerve block was given the same day, immediately after the PLDD procedure. The visual analogue scale (VAS) for pain was used during the pre-procedure and post-procedure periods. RESULTS: Among the patients who underwent one level PLDD, 88 had L4-L5 levels, 5 had L5-S1 levels and 2 had L3-L4 levels. L4-L5 and L5-S1 levels were the most common two-level PLDD locations in seven patients. Five patients in our study subsequently underwent open surgical treatment. All patients reported immediate pain relief, which was sustained after the procedure. The average pre-procedure VAS score was 7.6 (range from 5 to 8.2) and the VAS score immediately after the procedure was on average 0.5 (ranging from 0 to 2). CONCLUSIONS: Findings from this initial experience using a combi-therapy of CT-guided PLDD and CT-guided epidural nerve block have shown the benefits of this novel approach, offering significant immediate pain relief in the post-procedural phase, favorable outcomes in the short to mid-term and a significantly reduced rate of re-surgery (7%) compared with the use of only CT-guided PLDD. Lasers Surg Med 00:1-5, 2019. © 2019 Wiley Periodicals, Inc.

Microwave Thermal Ablation for Breast Cancer in Africa: A Pioneering Case Report Utilizing TATOpro.

The adoption of minimally invasive treatments for early-stage breast cancer is increasing. Microwave thermal ablation (MWA), a minimally invasive technique, has been studied for treating small breast cancer lesions. However, long-term evidence on its efficacy as a sole treatment is limited, as most studies combine MWA with other therapies and post-treatment surgical excision. This report details the case of an 83-year-old African patient who declined surgery and systemic therapies, opting for MWA using the TATOpro system as the sole treatment for contralateral breast cancer with axillary lymph node metastasis. The report includes a one-year follow-up, assessing disease recurrence with MRI and ultrasound. The findings highlight MWA's potential as an innovative and efficacious breast cancer treatment, emphasizing the need for adaptable strategies in oncology.

Advancing Breast Cancer Diagnosis: The Impact of Elastography Integration Into Breast Imaging Reporting and Data System (BIRADS) Categorization.

OBJECTIVE: This study evaluates the impact of integrating elastography into the Breast Imaging Reporting and Data System (BIRADS) categorization on breast cancer diagnostics in an African population. It explores the association and agreement between traditional BIRADS and those modified by elastography, as well as between quantitative and qualitative elastography methods. METHODS: A total of 200 participants who underwent breast imaging as part of their diagnostic evaluation for breast lesions were included in the study. Participant characteristics, including age distribution and indicators for breast cancer diagnoses, were analyzed. Brightness mode (B-mode) findings without elastography were assessed using the BIRADS classification. Elastography was integrated into the BIRADS categorization to evaluate its impact on breast cancer diagnostics. The association and agreement between BIRADS with and without elastography were analyzed. RESULTS: Participants predominantly aged 40-49 showed significant staging differences with the integration of elastography. Traditional B-mode staging identified 29 (49%) of participants in BIRADS stage IV and 14 (23%) in stage V, whereas elastography adjusted these figures significantly, enhancing diagnostic refinement. There was a fair agreement between BIRADS with and without elastography (kappa = 0.322), while a substantial agreement was found between quantitative and qualitative elastography (kappa = 0.674). CONCLUSION: The results of the study provide evidence that the integration of elastography into BIRADS categorization can significantly improve the accuracy of breast cancer diagnosis in African women. Elastography enhanced lesion characterization, supporting more personalized and precise clinical management. Continued research is needed to fully integrate elastography into routine diagnostic workflows and understand its broader clinical implications in Africa.

Shear Wave Elastography in Breast Cancer: Unveiling Correlations With Histopathological Grades and Subtypes.

Objective This study explores the correlation between shear wave elastography (SWE) features and histopathological grades and subtypes in breast cancer, aiming to enhance diagnostic accuracy and personalized treatment strategies. Methods The study retrospectively analyzed 59 consecutive women with breast cancer who underwent breast ultrasound with SWE. SWE parameters and histopathologic information, including histological type and grade, were recorded. Qualitative and quantitative SWE findings were analyzed, and B-mode findings were evaluated. Sociodemographic and clinical factors and B-mode findings were assessed as predictors of elastography stiffness using logistic regression analysis. Results Of the 59 participants diagnosed with breast cancer, invasive ductal carcinoma of no special type (IDC-NST) was predominantly found in 50 (84.7%) cases, followed by invasive medullary carcinoma in 5 (8.5%) cases. The majority of participants belonged to the 50-59 age group, comprising 19 (32.2%) patients. Histopathological grading revealed grade II tumors in 27 (45.8%) cases and grade III tumors in 24 (40.7%) cases. Notably, grade III tumors exhibited higher tissue stiffness compared to grade II tumors. Out of 36 stiff lesions, 30 (83.3%%) were IDC-NST while 3 (8.3%) were invasive medullary carcinoma. A significant association was observed between higher histopathological grade (grade III) and increased tissue stiffness (p < 0.05). Furthermore, among participants with stiff lesions, 21 (58.3%) exhibited color defects while 4 (23.5%) cases with soft lesions also displayed color defects Conclusion The correlation between SWE findings and histopathological grades and subtypes underscores the potential of SWE as a valuable tool for predicting tumor aggressiveness and characterizing specific subtypes. SWE enhances diagnostic accuracy and complements traditional imaging modalities, holding promise for personalized treatment strategies.

Anatomic Locations and Metastatic Risk in Prostate Cancer in African Men: Insights From an African Cohort.

BACKGROUND: There is significant variability in the pathogenetic characteristics of prostate cancer (PCa) across different anatomical zones. This study aims to understand the metastatic risk associated with these zonal predispositions among African men. METHODS: This hospital-based retrospective observational study included 120 biopsy-confirmed PCa patients examined between 2019 and 2023. Data on cancer history, sociodemographic, and clinical characteristics were collected from medical records. A logistic regression model was used to identify predictors of metastasis. RESULTS: The majority of PCa lesions were found in the left (60.0%) and right peripheral zones (55.8%), followed by the left (42.5%) and right transitional zones (41.7%). Lesions in the anterior fibromuscular stroma (crude odds ratio (cOR): 3.27, 95% confidence interval (CI): 1.13-9.47; p = 0.029), central gland (cOR: 5.38, 95% CI: 1.40-20.60; p = 0.014), and diffuse infiltration involving whole gland (cOR: 6.78, 95% CI: 1.17-30.07; p = 0.032) were associated with significantly increased odds of metastasis. Lesions in the anterior fibromuscular stroma were a marginally independent predictor of metastasis (adjusted odds ratio (aOR): 28.14, 95% CI: 0.96-822.46; p = 0.053). CONCLUSIONS: This study underscores the variability in metastatic risk of PCa lesions across different anatomical zones in African men. Lesions in the anterior fibromuscular stroma, central gland, and diffuse infiltration involving the whole gland have higher odds of metastasis. These findings highlight the need for targeted diagnostic and therapeutic strategies based on lesion localization to improve PCa management in this population.

Advancing Prostate Cancer Staging: A Single-Step Approach With Bi-parametric and Whole-Body Diffusion MRI in an African Cohort.

OBJECTIVES:  To document our initial experience using whole-body diffusion-weighted magnetic resonance imaging (WB-DWI/MRI) and bi-parametric magnetic resonance imaging (bpMRI) as a single exam in the staging of biopsy-proven prostate cancers. METHODS: This retrospective study involved 120 African men with biopsy-confirmed prostate cancer (PCa). All the participants had a single exam that included both a bpMRI and a WB-DWI/MRI. The results were analyzed based on the American Urological Association's risk stratification system and evaluated using descriptive statistics. RESULTS: The combined imaging approach confirmed PCa in all cases, identifying pelvic lymph node metastases in 21 (17.5%) patients. Among 72 high-risk patients, bpMRI+WB-DWI/MRI detected pelvic lymph node metastases in 18 (25.0%), bone metastases in 15 (20.8%), retroperitoneal lymph node metastases in six (8.3%), and extraprostatic extension in 18 (25%), with no solid organ metastases observed. CONCLUSION: The combination of WB-DWI/MRI and bpMRI in a single-step approach demonstrates diagnostic potential in primary prostate cancer staging for high-risk groups, with the added advantage of shorter examination times, lower patients' costs, and elimination of the risks of adverse events associated with the use of contrast agents and exposure to radiation.

Arteriovenous malformation of the ear optimized with cinematic rendering images: A case presentation and review of literature.

Arteriovenous malformations (AVMs) define rare aberrations in vascular morphogenesis. AVMs are typically present at birth, and unless they are stimulated to grow quickly by trauma, illness, or hormonal effects, they enlarge in proportion to an individual's growth. Clinical manifestations of AVMs are often linked to abnormal mass effects and blood perfusion. In this report, we describe a unique case of AVM of the left ear in a 24-year-old male, employing cinematic rendering along with a review of differential diagnosis and treatment options.

Progressive Memory Decline in a Patient With Atrial Septal Defect: Case Report and Literature Review.

Atrial septal defect (ASD) is a common congenital anomaly that increases the risk of heart failure as well as strokes which can lead to cognitive impairment. The risk of stroke is higher when pulmonary hypertension develops and there is reversal of shunt. Stroke in ASD may be due to paradoxical emboli from the right heart or a left ventricular thrombus which develops as a result of atrial fibrillation, a common arrhythmia in ASD. We present a case of a 32-year-old Ghanaian man with history of ASD who presented with progressive memory loss with magnetic resonance imaging scan of the brain showing multiple infarcts, microvascular disease, and cerebral atrophy.

Coarctation of the Aorta with Arterial Tortuosity Syndrome - A Case Report with Cinematic Rendering.

Coarctation of the aorta (CoA) with arterial tortuosity syndrome (ATS) is a rare hereditary condition characterized by elongation and tortuosity of the medium- and large-sized arteries, pulmonary hypertension, pulmonary artery stenosis, and constriction or narrowing of the aorta. Considering the non-specific indications and the overlap of ATS with other disorders of the connective tissue such as Williams Beuren syndrome (elastin), Marfan syndrome (fibrillin-1) and Ehlers Danlos syndrome (Type III collagen), it is vital to keep a high diagnostic suspicion in the analysis of the condition. We therefore report on a rare occurrence of coarctation of the aorta with arterial tortuosity syndrome in a teenage female who initially presented with severe resistant hypertension, providing additional literature to aid in the differential diagnosis of COA with ATS. Cinematic rendering delivered a markedly enhanced view of the condition, allowing for greater accuracy in the diagnosis.

Concurrent occurrence of a wandering spleen, organoaxial gastric volvulus, pancreatic volvulus, and cholestasis - A rare cause of an acute abdomen.

The concurrence of wandering spleen, organoaxial gastric volvulus, and pancreatic volvulus is very rare. They have been associated with symptoms such as severe abdominal pain, abdominal distention, and vomiting. However, the diagnosis remains complicated and any delay can result in ischemia and necrosis of the organs involved. In this case presentation, we present a unique case involving a 14-year-old girl who presented initially with acute abdominal pain. Assessment with enhanced computed tomography scan led to the diagnosis of wandering spleen, organoaxial gastric volvulus, and pancreatic volvulus, in addition to cholestasis, making it the first study to report on the simultaneous occurrence of this triad and cholestasis.

Age-gender distribution of coronary artery calcium score in a black African population in Ghana.

BACKGROUND: Distribution of coronary artery calcium (CAC) has been determined in different heterogeneous populations in the Multi-Ethnic Study of Atherosclerosis (MESA). Based on findings showing that geography and culture can influence CAC scoring beyond traditional race groups, we determined the distribution of CAC in a homogenous black African population to provide an initial basis for a larger CAC score study in Africa. METHODS AND RESULTS: This is a preliminary study using computed tomography to determine the CAC scores within a black African population who were referred to our center. Other information on patients were recorded through a combination of one-on-one interviews and medical records. A total of 170 patients were involved in our study, including 60.6% males, with an average age of 53.9 ± 9.2 years. The majority (78.8%) had a zero calcium score, with patients within the age group of 55-64 years dominating the non-zero calcium score population. Males were found to have higher calcium levels compared to females, and coronary artery calcification and prevalence steadily rose with the increasing age. However, P-values of 0.328 and <0.001 were observed with distribution of CAC according to gender and age, respectively. CONCLUSION: Findings from this study showed that the distribution of CAC was markedly affected by the age of our study population, which will be more apparent in a larger study.

Pulmonary aspergilloma: An evasive disease.

Aspergillomas are often misdiagnosed as tuberculosis (TB) in developing countries where the prevalence of TB is high, hemoptysis is often equated with TB, and most patients are diagnosed clinically. This report describes the case of a patient being treated for smear-negative TB who presented with hemoptysis and was found to have an aspergilloma.