Operative trends following the adoption of nonoperative management of rectal cancer.

BACKGROUND: Differentiating clinical near-complete and complete responses (cCR) after neoadjuvant therapy (NT) is challenging in rectal cancer patients. We hypothesized that magnetic resonance imaging staging limitations for low rectal cancers may increase the proportion of abdominoperineal resection (APR) with permanent colostomy for those without a cCR. METHODS: Single institution retrospective analysis of rectal cancer cases before and after adoption of nonoperative "watch and wait" (W&W) pathway. APR as a percentage of rectal resections was the primary outcome. RESULTS: There were 76 total mesorectal excisions (TME) in the pre-W&W group and 98 in the post-W&W group. NT was significantly more common in the post-W&W group. There was no significant difference in the APR primary outcome (pre-W&W APR 33.3% vs. post-W&W APR 26.5%, p = 0.482). APR patients had fewer complete TME grades (69.2% vs. 46.2%) and more pathologic complete responses (0% vs. 26.9%) in the post-W&W period. The cCR rate for patients with nonoperative management was 51.4% (n = 37) and 13.5% (n = 5) had regrowths, all of whom underwent salvage surgery. CONCLUSION: APR for those without a cCR to NT has not increased in the nonoperative management era. Balancing the pathologic complete response rate may require restaging some patients with clinical near-complete responses.

Characteristic Cerebrovascular Findings Associated with ACTA2 Gene Mutations.

A specific mutation (Arg179) of the ACTA2 gene has previously been described to cause a syndrome of multisystemic smooth muscle dysfunction with an extremely characteristic cerebrovascular appearance.1 Accurate neuroimaging diagnosis of this entity is important as this syndrome predisposes to complications such as early-onset ischemic stroke and ascending thoracic aortic aneurysm.2,3 The following case demonstrates a previously undescribed ACTA2 mutation (Met46) with an identical cerebrovascular imaging appearance to that of Arg179 mutations, but a less severe overall phenotype.

Left Ventricular Hypertrophy: Evaluation With Cardiac MRI.

OBJECTIVE: Left ventricular hypertrophy (LVH) is a frequent problem in clinical practice and can be caused by diverse conditions including hypertension, aortic stenosis, hypertrophic cardiomyopathy, athletic training, infiltrative heart muscle disease, storage and metabolic disorders. Identification of the precise etiology can be challenging and is a common cause of referral for cardiac MRI (CMR). In this article, CMR findings in various causes of LVH will be reviewed with an emphasis on determination of etiology and emerging role of CMR in risk stratification. CONCLUSIONS: In patients with LVH, CMR allows precise determination of the severity and distribution of hypertrophy, evaluation of ventricular function, and tissue characterization. The information obtained from CMR enables identification of the etiology of LVH and may aid in determining prognosis and therapy.