Radionucleotide Scan Research Articles

Managing a large staghorn stone in a Doughnut kidney

Doughnut or Pancake kidney is a condition in which both the kidneys fused at the medial borders of each pole to produce a ring-shaped mass. In addition to nonspecific lower abdomen discomfort, pyrexia and haematuria, signs of a urinary tract infection may also be present in an otherwise asymptomatic pancake kidney. Sometimes the diagnosis is coincidental. However different imaging modalities like USG, MDCT, computed tomography (CT) urography, and radio nucleotide scanning are use confirmed the diagnosis. Different surgical options such as open pyelolithotomy, laparoscopic or robot assisted pyelolithotomy can be consumed to treat such patient, however the literature proposes that an open pyelolithotomy is a safer and more rational approach to avoid injury to any aberrant vessels which are more common in such cases. KeyWord: Doughnut Kidney, Renal Stone, Pyelolithotomy

Cytomorphological Spectrum of Thyroid Lesions Based on Bethesda Reporting System: Diagnostic Utility and Pitfalls

Introduction: Fine Needle Aspiration Cytology (FNAC) is the frontline diagnostic tool in assessing Thyroid enlargement. FNAC is simple, easy to perform, cost effective procedure with rapid diagnosis. Other diagnostic tests like Ultrasound, radionucleotide scanning, Thyroid profile are adjuvant to FNAC which is more reliable. Aim: To categorise the spectrum of Thyroid lesions on FNAC according to the Bethesda system for Reporting Thyroid Cytopathology (TBSRTC) and study its utility and pitfalls. Materials and Methods: This was a retrospective observational study carried out in the Department of Pathology at Government Medical College/Government General Hospital, Mahabubnagar, Telangana, India, from January 2019 to December 2021. The analysis of the data was done from January 2022 to June 2022. FNAC and fine needling was performed in cases of enlarged Thyroid gland, the smears were prepared and fixed in 95% ethyl alcohol, stained with Hematoxylin and Eosin and Papanicolaou stain. Cytohistopathological concordance was done wherever was possible. Sensitivity, Specificity, Positive Predictive value, Negative Predictive value were calculated. Results: Out of 155 cytology cases, 8 cases (5.16%) were unsatisfactory/nondiagnostic, 133 cases (85.80%) were Benign lesions, 8 cases (5.16%) were follicular neoplasm/ suspicious for follicular neoplasm, No cases were reported as Atypia of undetermined significance, 3 cases (1.93%) were suspicious for malignancy and 3 cases (1.93%) were malignant. Cytohistopathological concordance was studied in 19 cases. One of the case reported on cytology as Anaplastic carcinoma was referred to higher center for further management. Conclusions: FNAC plays a pivotal role in diagnosis of Thyroid Swellings. The Bethesda system for reporting Thyroid Cytopathology effectively categorises the Thyroid lesions into various sub groups which facilitates better communication between the pathologist and clinician resulting in proper management of the patient. In this study, the number of Benign cases predominated and occurred in females. Cases presenting with nodular lesions, suspicious for malignancy and malignant lesions are advised surgical resection for further evaluation. The Bethesda system was found useful in categorisation of lesions and in advising medical or surgical management, urgency of treatment and the extent of surgery.

OR13-1 Long-Term Burosumab Therapy Provides Sustained Benefit in Patients with Tumor-Induced Osteomalacia: End of Study Findings From the Pivotal Phase 2 Study

Abstract Tumor-induced osteomalacia (TIO) is a rare paraneoplastic syndrome wherein small tumors secrete excess fibroblast growth factor 23 (FGF23) leading to hypophosphatemia, osteomalacia, bone pain, fractures, and muscle weakness. Burosumab is an anti-FGF23 monoclonal antibody approved for treatment of TIO. We report end of study (EOS) data from the open-label phase 2 UX023T-CL201 trial (NCT02304367) of burosumab in adults with TIO. In UX023T-CL201, participants received burosumab (0.3–2.0 mg/kg) by subcutaneous injection every 4 weeks for 48 weeks with an extension up to 300 weeks (∼6 years). Co-primary endpoints were change in serum phosphorus at Week 24 and change in excess osteoid by trans-iliac crest bone biopsy at Week 48. Additional endpoints included changes in bone biomarkers, activity on radionucleotide bone scan representing fractures/pseudofractures, patient-reported outcomes, and safety measures. This analysis included 14/17 UX023T-CL201 participants; excluding those with other diagnoses (n=3). Mean (SD) serum phosphorus improved from 1.6 (0.5) mg/dL at baseline to 2.3 (0.5) mg/dL when averaged across the mid-point of the dose interval through Week 24 (co-primary endpoint). Levels further improved (2.6 [0.4] mg/dL; n=7) to within the normal range (2.5–3.6 mg/dL) at Week 240. Most measures of osteomalacia improved at Week 48 (co-primary endpoint), including osteoid/bone volume, osteoid thickness, and mineralization lag time. However, osteoid surface/bone surface showed no change. Bone biomarkers (P1NP, CTx, BALP) followed similar trends. Upon initiation of burosumab, markers briefly increased by Week 24 as bone healing began, then gradually decreased with further treatment, reaching normal (P1NP, CTx) or near-normal (BALP) ranges by Week 240. At baseline, 249 areas of increased radionucleotide uptake indicating fracture activity were detected across 14 participants. By Week 144, 36% (72/201) and 13% (26/201) regions of abnormal uptake were fully or partially restored, respectively. By EOS, further reduction of active fractures and fewer new areas of uptake were observed. New fractures at Week 144 were observed in a single participant (considered a burosumab partial responder) and between Week 144 and EOS in another participant unrelated to burosumab (car accident). Participants reported sustained mean reduction from baseline pain at Week 240 per Brief Pain Inventory and significantly per SF-36 Bodily Pain score. Significant reductions in baseline fatigue at Week 240 were reported per Brief Fatigue Inventory and SF-36 Vitality scores. SF-36 physical health (Role Physical, Bodily Pain, Component Score) and mental health (Social Function, Vitality) significantly improved from baseline at Week 240. The observed safety profile of long-term burosumab in participants with TIO was consistent with the known safety profile of burosumab and similar to patients with XLH. Long-term burosumab therapy was associated with improved serum phosphorus, osteomalacia, bone turnover, fracture incidence and healing, health-related quality of life, and reductions in pain and fatigue in adults with TIO. Presentation: Sunday, June 12, 2022 11:00 a.m. - 11:15 a.m.

Sensors and Techniques for Creatinine Detection: A Review

The use of biochemical markers in the kidney healthcare has advanced dramatically in recent years. Creatinine and Blood Urea Nitrogen (BUN) are two of the most essential biochemical markers that can help a concerned physician, nephrologist, or oncologist to understand the qualitative and quantitative functions of the kidneys. Monitoring serum creatinine levels is critical for renal health indicators such as creatinine and BUN. When people are diagnosed with kidney illness, they are usually prescribed with a regular blood test, ultrasound, MRI, X-ray, and/or CT scan, as well as hybrid radionucleotide scans like SPET/PET. These are conventional approaches that are commercially available. The blood test allows for a precise knowledge of serum creatinine and BUN levels, which aids in determining the blood’s waste content and kidney functioning levels. However, these approaches are expensive, time intensive, and necessitate the use of technical professionals to undertake medical analysis on patients. As a result, new biosensing approaches for detecting creatinine as a biomarker have been developed by several research groups. It is hoped that the development of a quick and low-cost Point-of-Care (PoC) device would aid in more regular monitoring of renal healthcare, which will be useful in detecting early stages of kidney function loss.

Thyroid Disorders.

Thyroid Disorders.

Acquired Facial, Maxillofacial, and Oral Asymmetries—A Review Highlighting Diagnosis and Management

Facial asymmetry refers to the absence of, or the deviation from the regular mirror image of facial structures, relative to a referenced midline axis. It can be attributed to a wide spectrum of deformities, including congenital, developmental, or acquired conditions, which can originate either prenatally or postnatally. Though highly prevalent, asymmetry commonly goes undiagnosed due to its subtle or relative nature. Among the spectrum of conditions, acquired cases are triggered postnatally, in previously normal individuals, thus subjecting them to sudden, eventful psychological and psychosocial disharmony. When detected early, timely management may help intervene progressive growth of these conditions. This, therefore, emphasizes the need for a thorough diagnostic workup including medical/dental history, clinical examinations, study models, photographic and radiographic records for a case-by-case basis to prevent severe functional and aesthetic complications. Recently, advanced diagnostic procedures, such as stereophotogrammetry, 3D stereolithographic models, skeletal scintigraphy (radionucleotide scans), 3D computed tomographic scans, cone-beam computed tomography, and magnetic resonance imaging, have provided innovative diagnostic instruments for numerous craniofacial defects. This descriptive review aims at focusing on the factors leading to frequently encountered conditions of acquired facial asymmetry and highlights their clinical evaluation, conservative and surgical interventions by a multi-disciplinary team of clinicians.

NEPHROPLEURAL FISTULA AND URINOTHORAX AFTER PERCUTANEOUS NEPHROLITHOTOMY

SESSION TITLE: Fellows Disorders of the Pleura Posters SESSION TYPE: Fellow Case Report Posters PRESENTED ON: October 18-21, 2020 INTRODUCTION: Urinothorax is a rare diagnosis caused by urinary tract obstruction or trauma resulting in leakage of urine from the retroperitoneum into the pleural space. These effusions are typically large, unilateral, and nearly always associated with a ratio of pleural fluid creatinine to serum creatinine greater than one. Definitive treatment requires correction of the uropathy, as thoracentesis or chest tube insertion alone is invariably ineffective. Here we describe a case of urinothorax due to nephropleural fistula which formed after percutaneous nephrolithotomy for staghorn calculi. CASE PRESENTATION: A 54 year-old female with morbid obesity and bilateral staghorn calculi was admitted to the hospital for elective bilateral percutaneous nephrolithotomy (PCNL) for progressive renal dysfunction. A left sided PCNL was performed and a percutaneous nephrostomy (PCN) tube was left in place. Four days post procedure, the PCN tube was removed. Six days post procedure, the patient developed severe left-sided pleuritic chest pain, orthopnea, and dyspnea at rest. She required two liters of oxygen by nasal cannula to maintain her oxygen saturation above 90%. Exam was notable for super morbid obesity (BMI of 60), mild respiratory distress, and absent left sided breath sounds with dullness to percussion. Chest x-ray showed a large left pleural effusion. Urgent bedside thoracentesis was performed, and 1.8 liters of clear, pink-tinged fluid was removed. Pleural fluid analysis revealed a transudate by Light’s criteria with a pH of 7.8, creatinine of 6.69 mg/dL, and a pleural fluid to serum creatinine ratio of 2.9. CT scan of her chest, abdomen, and pelvis revealed bilateral staghorn calculi, a large left pleural effusion, and a fistulous tract between the kidney and the posteroinferior pleural space. A chest tube was placed, and the patient underwent double J-stent placement within the urinary tract which relieved the obstruction and halted the accumulation of pleural fluid. The chest tube was removed, and the patient was discharged with plans to undergo right sided PCNL in the future. DISCUSSION: Urinothoraces can be caused by urinary tract obstruction or trauma. PCN tube placement above the 12th rib can lead to pleural transgression and injury, as in this case. Traumatic urinothoraces are typically symptomatic, unilateral, and large. In most cases, pleural fluid analysis shows an acidic transudate with a pleural fluid to serum creatinine ratio of greater than one. Diagnosis can be made on the basis of pleural fluid analysis or imaging with either CT or radionucleotide scans. Treatment with thoracentesis or chest tube drainage alone leads to unfavorable outcomes in nearly all cases; therefore, management should focus on correction of the uropathy which provides definitive treatment. CONCLUSIONS: See Discussion Reference #1: Toubes, M. E et al. Urinothorax: a systematic review. J Thorac Dis. 2017 May; 9(5): 1209-1218. Reference #2: Chandra A, Pathak A, Kapur A, Russia N, Bhasin N. Urinothorax: A rare cause of severe respiratory distress. Indian J Crit Care Med. 2014;18(5):320-2. Reference #3: Dagli M, Ramchandani P. Percutaneous nephrostomy: technical aspects and indications. Semin Intervent Radiol. 2011;28(4):424–437. DISCLOSURES: No relevant relationships by Traci Adams, source=Web Response No relevant relationships by Carlos Cardenas, source=Web Response No relevant relationships by Dylan Lovin, source=Web Response no disclosure on file for Arthi Satyanarayan

Necessity of routine cardiac evaluation in patients receiving pegylated liposomal doxorubicin for gynecologic cancer

ObjectivePegylated liposomal doxorubicin (PLD) has similar reported clinical efficacy compared with conventional doxorubicin with less cardiotoxicity. The manufacturer of PLD advises that cardiac function should be evaluated with endomyocardial biopsy, echocardiography or multigated radionucleotide scan (MUGA) pre-treatment and during therapy. This study was designed to assess the necessity of pre-treatment cardiac evaluation in patients receiving PLD. MethodsAfter IRB approval, a retrospective study of all women with gynecologic cancer who received PLD from 2006 to 2018 was performed. Demographic information, treatment records, cardiac risk factors, and cardiac surveillance testing were examined. Wilcoxon signed rank sum test and logistic regression were used to evaluate the association of cumulative PLD exposure with cardiotoxicity. ResultsA total of 235 patients received PLD for gynecologic cancer. Patients received a median of 3 cycles of PLD with a cumulative dosage of 237 mg over a median follow-up time of 24 months. Sixteen patients in the cohort (7%) had no cardiac surveillance at all. Of the remaining patients who underwent cardiac testing, 183 (84%) received MUGA scans and 36 (16%) had echocardiography. Of the 56 patients who had both pre- and post-treatment cardiac testing, there was no significant difference in median ejection fraction (p = 0.17). Three patients developed PLD-associated cardiac toxicity but only one patient had severe manifestations requiring discontinuation of PLD therapy. ConclusionsRoutine cardiac testing before, during or after treatment with PLD may be unnecessary. Cardiac testing may be more appropriate for individual patients for whom the clinical suspicion of PLD-related cardiac toxicity is high.

Visual Vignette

Case Presentation: A 61-year-old African American female with a past medical history of sarcoid, diabetes, hypertension, end-stage renal disease status post–left nephrectomy presented for surgical evaluation for a potential kidney transplant. Upon work-up for renal transplant, the patient was found to have an intact parathyroid hormone level of 1,888 pg/mL (reference range, 12 to 72 pg/mL), serum calcium of 9.9 mg/dL (reference range, 8.8 to 10.2 mg/dL), serum creatinine of 8.9 mg/dL (reference range, 0.60 to 1.20 mg/dL), and serum phosphorus of 3.5 mg/dL (reference range, 2.4 to 4.4 mg/dL). The physical examination was normal. Given the degree of elevation of parathyroid hormone, the patient underwent evaluation with 99mTc sestamibi radionucleotide scan with single-photon emission computed tomography (SPECT)/computed tomography (CT). The planar images showed increased uptake in the anterior superior mediastinum, with no abnormal uptake in the areas of parathyroids and normal uptake in salivary glands and thyroid (Fig. 1). Further evaluation with SPECT/CT showed a focal area of increased radiotracer uptake in the anterior superior mediastinum (Fig. 2). What is the diagnosis? Fig. 2 View Large Image Figure Viewer

Pancake kidney: when it is not a problem.

Pancake kidney is a very rare congenital anomaly involving complete fusion of medial renal parenchyma. The interface is devoid of any intervening septum. As described, the kidneys form a single lobulated mass in pelvic location. However, dual collecting systems are retained, and the shortened, anteriorly seated ureters enter the bladder normally. This condition is usually discovered incidentally but may confer a heightened susceptibility to recurrent urinary tract infections or stone formation, given the likelihood of anomalous collecting system rotation and the potential for ureteral stasis or obstruction. Excretory urography, the customary method of detection, has been replaced by ultrasonography, CT, MRI, and radionucleotide scanning. Herein, we present a male patient with a pelvic pancake kidney, never symptomatic. A conservative approach of regular follow up visits and laboratory testing was elected, thus avoiding any unnecessary investigations or extensive surgery.

A study of correlation of fine-needle aspiration cytology with postoperative histopathological examination in patients with either solitary thyroid nodule or multiple nodules

Background Fine-needle aspiration cytology (FNAC) of the thyroid gland is now a well-established, first-line diagnostic test for the evaluation of thyroid nodules with the main purpose of confirming benign lesions and thereby, reducing unnecessary surgery. Different imaging techniques are now used for diagnosis of thyroid nodules like radionucleotide scanning and ultrasonography. However, FNAC is still regarded as the single most accurate and cost-effective procedure, particularly if ultrasound is used as a guide for better sample collection, especially for cystic lesions. Aim The aim of the work is to evaluate the correlation of preoperative FNAC with postoperative histopathological examination in patients with either solitary thyroid nodule and multiple nodules. Patients and methods This prospective study was done between April 2016 and November 2017 on 100 patients presented to the General Surgical Department with either solitary or multiple thyroid nodule. This was done to assess the correlation between preoperative FNAC and postoperative histopathological examination. Results Statistical analysis of our study showed sensitivity, specificity, accuracy, false-positive fraction, false-negative fraction, positive predictive value, and negative predictive value of FNAC to be 92, 81, 84, 36, 3.3, 63, and 96%, respectively. Conclusion The FNAC is a sensitive, specific, and accurate initial diagnostic test for the preoperative evaluation of patients with thyroid swellings in our setting as well. The correlation of cytological and histopathological diagnoses is an important quality assurance method, as it allows cytopathologists to calculate their false-positive and false-negative results.

Splenogonadal fusion in an 18-month-old

Splenogonadal fusion is rare abnormal congenital connection of splenic tissue and gonad. It commonly presents with either cryptorchidism or as a palpable mass. As a benign anomaly, orchiectomy is often unnecessary. Removal of the splenic component may be accomplished with preservation of the testicle. An 18-month-old boy presented with right cryptorchidism and left retractile testicle. Laparoscopic examination found a viable right testicle, and a successful orchiopexy was performed. The left testicle demonstrated splenogonadal fusion. Discontinuous accessory splenules were noted along the path of testicular descent. After confirmation from a radionucleotide liver-spleen scan the patient was brought back to the operating room for open excision of the adherent splenic tissue and orchiopexy of the testicle via an open inguinal approach. Splenogonadal fusion is a rare condition, but may be suspected in children with cryptorchidism or palpable peri-testicular mass. As with the present patient, in most cases the splenic tissue may be successfully excised without injury to the testicle.

Factors determining renal impairment in unilateral ureteral colic secondary to calcular disease: a prospective study.

To evaluate all possible risk factors that can cause impairment of overall renal function in patients with unilateral ureteral calculus and a normal contralateral kidney. This is a prospective study of 90 patients who presented to our institute complaining of renal colic secondary to unilateral ureteral calculus. All patients were evaluated with a thorough history, physical examination, and laboratory and radiological investigations including renal function testing, urine analysis, non-contrast computed topography, and radionucleotide scan. Patients were divided into two groups according to their calculated creatinine clearance using the Modification of Diet in Renal Disease (MDRD) formula. Group I (favorable group) had a creatinine clearance >60 ml/min, while group II (unfavorable group) had a creatinine clearance <60 ml/min. The patients' mean age ± SD was 38.8 ± 11.4 years. Group I included 54 patients (60 %), while group II included 36 patients (40 %). On univariate analysis, factors that were associated with overall renal function impairment were patients' age, urea-to-creatinine ratio (UCR), use of nonsteroidal anti-inflammatory drugs, stone location, and presence of obstruction. However, using binary logistic regression analysis, only patients' age, UCR, and presence of obstruction sustained statistical significance in association with renal function impairment. The study of factors that help explain the presence of renal impairment in patients with unilateral ureteral calculus is important in the clinical setting. Patients' age, urea-to-creatinine ratio, and degree of obstruction seem to be significantly associated with overall renal function impairment.

Paget's disease of bone: an endocrine society clinical practice guideline.

The aim of this guideline was to formulate practice guidelines for the diagnosis and treatment of Paget's disease of the bone. The guideline was developed by an Endocrine Society-appointed Task Force of experts, a methodologist, and a medical writer. This evidence-based guideline was developed using the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) system to describe both the strength of recommendations and the quality of evidence. One group meeting, several conference calls, and e-mail communications enabled consensus. Committees and members of The Endocrine Society and the European Society of Endocrinology reviewed and commented on preliminary drafts of these guidelines. Two systematic reviews were conducted to summarize supporting evidence. We recommend that plain radiographs be obtained of the pertinent regions of the skeleton in patients with suspected Paget's disease. If the diagnosis is confirmed, we suggest that a radionucleotide bone scan be done to determine the extent of the disease. After diagnosis of Paget's disease, we recommend measurement of serum total alkaline phosphatase or, when warranted, a more specific marker of bone formation or bone resorption to assess the response to treatment or evolution of the disease in untreated patients. We suggest treatment with a bisphosphonate for most patients with active Paget's disease who are at risk for future complications. We suggest a single 5-mg dose of iv zoledronate as the treatment of choice in patients who have no contraindication. In patients with monostotic disease who have a normal serum total alkaline phosphatase, we suggest that a specific marker of bone formation and bone resorption be measured, although these may still be normal. Serial radionuclide bone scans may determine the response to treatment if the markers are normal. We suggest that bisphosphonate treatment may be effective in preventing or slowing the progress of hearing loss and osteoarthritis in joints adjacent to Paget's disease and may reverse paraplegia associated with spinal Paget's disease. We suggest treatment with a bisphosphonate before surgery on pagetic bone.

Fine needle aspiration cytology of thyroid lesions and its correlation with histopathology in a series of 248 patients.

Thyroid swellings are a significant clinical problem in the general population but majority of them are nonneoplastic and do not require surgery. The initial screening procedures include ultrasonography, fine needle aspiration cytology (FNAC) and radionucleotide scan. An initial screening test which will diagnose thyroid lesions accurately will help to avoid surgery in nonneoplastic conditions. The aim of the present study is to correlate the cytology findings with final histopathology. Two hundredand forty-eight cases of thyroid nodules which underwent FNAC followed by surgery were included in this study. The cytology diagnoses were classified into nondiagnostic/unsatisfactory, benign, atypia of undetermined significance/follicular lesion of undetermined significance, follicular neoplasm/suspicious for a follicular neoplasm, suspicious for malignancy and malignant. The fine needle aspiration diagnosis was compared with the histopathology diagnosis. In majority of cases the FNA diagnosis was in concordance with final histopathology. A high incidence of follicular variant of papillary carcinoma thyroid was detected in this study. The awareness of this entity and the search for fine nuclear details of papillary carcinoma can lead to proper identification of this category of tumors and thus help to avoid false negative and equivocal results. Fine needle aspiration cytology is a simple, cost effective, rapid to perform procedure with high degree of accuracy and is recommended as the first line investigation for the diagnosis of thyroid lesions.

A 60-Year-Old Man With Chronic Cough and Green Sputum

Question: A 60-year-old man with a past medical history of pancreatic neuroendocrine tumor with metastasis to the liver, chronic cholangitis, and liver abscess presented with a 2-month history of productive cough with green sputum and right upper quadrant pain. Past surgical history includes partial liver resection, liver chemoembolization and Y-90 microsphere radiation, cholecystectomy, and multiple intraabdominal surgeries. On examination, the patient was a cachectic-appearing white male. Oral cavity examination shows a greenish coating on tongue but no jaundice. Significant laboratory results included an alkaline phosphatase level of 523 U/L (normal, 55-135), aspartate aminotransferase of 57 U/L (normal, 10-40), and normal bilirubin level. Computed tomography was nondiagnostic. Magnetic resonance cholangiopancreatography without contrast revealed several nonspecific areas of abnormal increased T2 signal adjacent to the liver at the hepatic dome and within the right lower lobe of the lung, numerous poorly defined hepatic lesions. As part of his evaluation, a HIDA scan was performed (Figure A, results at 5 minutes; Figure B, at 40 minutes). Endoscopic retrograde cholangiopancreatography (ERCP) was then performed for diagnosis and therapeutic intervention (Figure C). What is the diagnosis? What is the appropriate management? Look on page 576 for the answer and see the Gastroenterology web site (www.gastrojournal.org) for more information on submitting your favorite image to Clinical Challenges and Images in GI.

The Rate and Mortality of Postoperative Venous Thromboembolism of Moderate Risk Surgery in Asian Patients without Thrombo‐prophylaxis: Systematic Review with Meta‐analysis

The general gynecologic and neurologic surgeries are regard as carrying moderate risk for postoperative venous thromboembolism (VTE). This review analyzed the postoperative VTE rate of these surgeries in Asia. Inclusion criteria were: prospective study; deep vein thrombosis (DVT) diagnosed by venography, ultrasonography, or radionucleotide scan; and no thromboprophylaxis. The pooled proportion was back calculated from Freeman-Tukey variant transformation, using a random effect model. Medline, EMBASE, Cochrane Library, and KoreaMed were searched. Fourteen studies (total population of 1,625) published from 1974 to 2008 were included. In general surgery, the pooled rate of all-sites proximal, isolated distal DVT was 13.4, 2.1, and 11.8 % (radionucleotide scan). The cancer patients carried a higher all-sites DVT rate (19.7 % radionucleotide scan and 17.4 % ultrasound). Gynecologic and neurologic surgery had 3.1 % (ultrasound) and 3.8 % (radionucleotide scan) all-sites DVT rate. For general, gynecologic, and neurologic patients, the pooled rates of symptomatic DVT were 1.5, 0.2, and 1.0 % respectively. The pooled rate of symptomatic pulmonary embolism (PE) was 0.4 % for general surgery. No patients died from PE (pooled rate 0.2 %); however, a single PE death was reported in the excluded study. Postoperative symptomatic VTE was relatively low in Asia. Further study is required to stratify VTE risk and the need for thromboprophylaxis in individual patients.

Pediatric Neck Masses

Pediatric Neck Masses

Sequential Real-Time PCR Assays Applied to Identification of Genomic Signatures in Formalin-Fixed Paraffin-Embedded Tissues: A Case Report AboutBrucella-Induced Osteomyelitis

Brucellosis is a zoonotic infection transmitted from animals to human by ingestion of infected food products, direct contact with an infected animal, or inhalation of aerosols. Brucella infection-induced osteomyelitis may present only with nonspecific clinical and radiographic findings, mild elevations in serum inflammatory markers, as well as nonspecific histological changes. We studied a case of an Iraqi war veteran with multifocal vertebral body and left iliac bone lesions on radio nucleotide scans and magnetic resonance imaging, clinically suspected osteomyelitis possibly because of Brucella. Although histomorphological findings were nonspecific, consisting of chronic inflammatory cell infiltrate and reactive fibrosis, tissue gram and silver impregnation stains of bone biopsies were informative, revealing gram-negative coccobacilli consistent in size with Brucella species. Total nucleic acids were extracted from formalin-fixed paraffin-embedded tissues and amplified by sequential real-time polymerase chain reaction, targeting genes coding (1) outer membrane protein (omp-31) of Brucella species and (2) insertion sequence (IS711) of Brucella abortus (b-abt). Polymerase chain reaction results confirmed B. abortus as the causative pathogens for presumed diagnosis of Brucella osteomyelitis.

Paraoesophageal splenosis: An unusual differential of mediastinal soft tissue deposits.

Ectopic splenic tissue can present as accessory spleens and splenosis. While accessory spleens are congenital and more common; splenosis occurs as a result of implantation of splenic tissue as a result of trauma or iatrogenic injury. Only up to 40 intrathoracic splenosis have been reported in the English language literature to date. Here we discuss a case in which Para oesophageal pre-aortic ectopic splenic tissue was identified through radionuclide imaging 20 years after splenic rupture in a 44-year-old male for work up of epigastric pain.Splenosis should be considered as differential diagnosis in all previously splenectomised patients who present with unexplained masses on imaging. Early diagnoses with preoperative non-invasive radionucleotide scanning with collateral histories can prevent unnecessary surgery and reduce expensive and invasive investigations.