Technical Considerations for Red Marking Ink Use When Interpreting Specimen Radiographs: Case Report.

Artifacts are universal across all imaging modalities, varying in their conspicuity and significance. In this report three patients with pathology-proven breast cancer who had densities masquerading as microcalcifications at the resection margins of the lumpectomy specimens, but had negative microscopic margins, will be discussed. It was determined that these pseudocalcifications were the result of ink precipitates from a commonly utilized tissue marking dye. This artifact was further evaluated and reproduced by utilizing a boneless chicken breast as a phantom. © RSNA, 2016.

The new face of war: Craniofacial injuries from Operation Inherent Resolve.

BACKGROUND: During the last 20 years of conflict in the Middle East, improvements in body armor and the use of improvised explosive devices have resulted in an increased incidence of complex craniofacial trauma (CFT). Currently, CFT comprises up to 40% of all casualties. We present new data from the recent conflict in Iraq and Syria during Operation Inherent Resolve. METHODS: Data were collected for patients treated at role 1, role 2, and role 3 facilities in Iraq and Syria over a 1-year period. During this time, a specialized head & neck surgical augmentation team was deployed and colocated with the central role 3 facility. Data included for this cross-sectional study are as follows: injury type and mechanism, triage category, initial managing facility and subsequent levels of care, and procedures performed. RESULTS: Ninety-six patients sustained CFT over the study period. The most common injuries were soft tissue (57%), followed by cranial (44%) and orbital/facial (31%). Associated truncal and/or extremity injuries were seen in 46 patients (48%). There were marked differences in incidence and pattern of injuries between mechanisms (all p < 0.05). While improvised explosive devices had the highest rate of cranial and truncal injuries, gunshot wounds and blunt mechanisms had higher incidences of orbital/facial and neck injuries. Overall, 45% required operative interventions including complex facial reconstruction, craniotomy, and open globe repair. Mortality was 6% with 83% due to associated severe brain injury. Most patients were local nationals (70%) who required discharge or transfer to the local health care system. CONCLUSION: Complex craniofacial trauma is increasingly seen by deployed surgeons, regardless of subspecialty training or location. Deployment of a centrally located head and neck team greatly enhances the capabilities for forward deployed management of CFT, with excellent outcomes for both US and local national patients. LEVEL OF EVIDENCE: Therapeutic/care management; Level V.

Successful percutaneous embolization of refractory chylous ascites following peritoneal lymph node dissection.

Chylous leaks are an uncommon complication in patients undergoing surgical procedures with the majority of cases responding to conservative therapies. Described is a case of a 23-year-old male who developed debilitating refractory chylous ascites as a complication after retroperitoneal lymph node dissection for testicular cancer. Prior to being evaluated by interventional radiology, he required weekly large-volume paracentesis in addition to standard conservative therapies. The patient underwent a single percutaneous treatment of a localized chylous leak involving a retroperitoneal lymphatic duct by utilizing a combined fenestration and embolization technique. Complete resolution of the patient's condition occurred within 3 weeks. No immediate or delayed complications were observed during the 6-month follow-up period.

Emergency department screening and intervention for patients with alcohol-related disorders: a pilot study.

CONTEXT: Physicians in emergency departments (EDs) treat more patients with alcohol-related disorders than do those in primary care settings. OBJECTIVES: To implement an effective screening, brief intervention, and referral (SBIR) program for use in EDs. Further, to evaluate the impact of the program on alcohol-consumption levels. METHODS: A prospective cohort pilot study was conducted at a suburban community teaching hospital using a convenience sample of ED patients and an original seven-question screening tool based on well-known guidelines. Subjects screening positive for possible alcohol abuse were given treatment referrals. Follow-up telephone interviews were conducted 6 months later. RESULTS: Of the 1556 enrolled subjects, 251 (16%) were classified as at-risk drinkers. Seventy-nine at-risk subjects (32% [95% CI, 26%-37%]) screened positive on CAGE-based questions (Cut down, Annoyed, Guilty, Eye opener). At follow-up, 20 (25% [95% CI, 16%-35%]) were successfully contacted. Of these 20 subjects, 5 (25%) refused to participate in follow-up screening. For the remaining 15 individuals, follow-up screening indicated that the mean (SD) number of drinks consumed per week decreased from 28 (14) on study enrollment to 10 (10) at 6-month follow-up (P<.001). Maximum number of drinks per occasion decreased from 12 (8) at enrollment to 6 (7) on follow-up (P=.008). Subject scores on the CAGE-based questions decreased from pre- to postintervention, though not significantly, with an average of 2.1 (1) affirmative answers on enrollment and 1.5 (1.4) at follow-up (P=.108). CONCLUSION: Implementation of an effective SBIR program for alcohol-related disorders can be accomplished in the ED.