Inflammatory Myofibroblastic Tumor of the Urinary System on Computed Tomography at a High-Volume Institution in China

2020 ◽  
Vol 104 (11-12) ◽  
pp. 960-967
Author(s):  
Bo Chen ◽  
Shuang Li ◽  
Xin Fang ◽  
He Xu ◽  
Jianqun Yu ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Clinical Decision Making ◽  
Clinical Manifestations ◽  
High Volume ◽  
Clinical Decision ◽  
Imaging Features ◽  
Urinary System ◽  
Eligibility Criteria ◽  
Enhanced Computed Tomography

<b><i>Objective:</i></b> Inflammatory myofibroblastic tumors (IMTs) of the urinary system are relatively rare and often misdiagnosed. We aimed to summarize and analyze the clinical manifestations, imaging features, management, and follow-up of renal and bladder IMTs. <b><i>Methods:</i></b> In this retrospective study, 22 patients with IMT pathologically verified between 2009 and 2018 were included. Epidemiologic, clinical, pathologic, and imaging findings were recorded. Tumor size, location, and shape were analyzed and summarized. <b><i>Results:</i></b> There were 22 patients with a median age of 45 years (range: 20–74), including 14 patients with renal IMT and 8 patients with bladder IMT, who met the eligibility criteria. In 21 patients, IMT appeared as a single lesion, whereas 1 patient showed bilateral renal lesions. Surgical resection was the sole therapy, and follow-up information was acquired from 13 individuals with no evidence of recurrence or metastasis. In our study, a slightly hypodense or isodense homogeneous tumor with a clear boundary was more often seen. On contrast-enhanced computed tomography (CT), they were often manifesting as a slightly heterogeneous enhancement. <b><i>Conclusions:</i></b> The nature of IMTs might cause a lack of generalizability. However, it will be useful to know that there are various CT demonstrations of IMTs. CT images are useful for the detection, location, and characterization of urinary IMTs, which can help in better clinical decision-making and can also be an optimal imaging technique for follow-up.

Effects of Telehomecare Interventions on the Management and Complications of Diabetes Mellitus: Protocol for a Systematic Review and Meta-Analysis

2021 ◽  
Author(s):  
Hamidreza Dehghan ◽  
Maryam Morshediam ◽  
Arezoo Dehghani ◽  
Masoud Mirzaei ◽  
Farhad Fatehi
Keyword(s):  
Systematic Review ◽  
Clinical Decision Making ◽  
Diabetes Management ◽  
Meta Analysis ◽  
Health Resources ◽  
Diabetes Type 2 ◽  
Clinical Decision ◽  
Long Distance ◽  
Eligibility Criteria

Background: Diabetes is one of the most serious health challenges of the 21st century. The number of adults with diabetes has roughly tripled in the last 20 years. The increased burden of chronic diseases and scarce health resources compel healthcare systems to make modern patients more self-sufficient by requiring them to play a more active part in the treatment and management of their disease. Tele-home-care is a method of distance intervention through the transmission of electronic data for follow-up, education, prevention, clinical decision-making, and treatment modulation that has a high potential for the population with diabetes. Previous studies have not systematically evaluated the effects of different features of long-distance caregiving on diabetes at different stages of disease severity. Objectives: The present study describes a protocol for a systematic review and meta-analysis for summarizing the evidence comparing telehomecare interventions on diabetes management and its complications. Methods: PubMed, Scopus, ISI Web of Science, Cochrane databases, HTA (Health Technology Assessment), NHS EED (NHS Economic Evaluation Database), DARE (Database of Abstract of  Reviews of Effects), Embase, and SID will be searched using medical subject heading (MeSH) keywords. Controlled clinical trials in patients with type 1 diabetes, type 2 diabetes, and gestational diabetes will be selected based on predefined eligibility criteria. The risk of bias in studies will be checked using the JADAD score. The mean difference and its standard deviation will be calculated to be used as effect size. A random-effects meta-analysis was performed to pool the results. Subgroup analysis and meta-regression will be conducted to explore the possible sources of heterogeneity. Conclusion: The systematic review and meta-analysis provided by the results of a systematic review can be useful to endocrinologists, physicians, public health policymakers, and the general population.

scholarly journals Missed Diagnosis of Subarachnoid Haemorrhage

2021 ◽  
Author(s):  
Teiko Kawahigashi ◽  
Taro Shimiszu ◽  
Takashi Kawabe ◽  
Yoshitoshi Kida ◽  
Kazunao Watanabe
Keyword(s):  
Computed Tomography ◽  
Subarachnoid Haemorrhage ◽  
Clinical Decision Making ◽  
Clinical Decision ◽  
Blurred Vision ◽  
Orbital Pain ◽  
Life Threatening ◽  
Missed Diagnosis ◽  
Head Computed Tomography

A 79-year-old woman presented with left retro-orbital pain, headache and blurred vision. Based on negative radiological tests, life-threatening conditions like subarachnoid haemorrhage (SAH) were ruled out and outpatient follow-up was planned. However, the patient returned to the hospital that night because of progressively declining consciousness and was diagnosed with SAH by head computed tomography. The diagnosis of SAH is often challenging, especially in cases with negative radiological results. We describe some strategies, other than radiological examination, for ruling out SAH, such as performing a lumbar puncture and repeating tests to take account of disease progression, and describe biases which can affect clinical decision-making.

scholarly journals A RARE CASE OF RAPIDLY ENLARGING MYELOLIPOMA IN SICKLE CELL DISEASE

2020 ◽  
Vol 6 (2) ◽  
pp. e54-e58
Author(s):  
Paran Davari ◽  
Cortney Youens Lee ◽  
James Te-An Lee
Keyword(s):  
Computed Tomography ◽  
Sickle Cell Disease ◽  
Sickle Cell ◽  
Adrenal Mass ◽  
Rare Case ◽  
Clinical Manifestations ◽  
Endocrine Surgery ◽  
Imaging Features ◽  
Cell Disease

Objective: Adrenal myelolipoma (AM) is a benign tumor composed of mature fat cells and hemopoietic elements. Most AMs are incidental findings on imaging and clinically asymptomatic. The purpose of this case report is to describe a rare case of AM and explore its clinical manifestations, imaging features, and treatment. Methods: In this study, we report a case of a rapidly growing right AM in a patient with uncontrolled hemoglobin sickle cell disease. A 38-year-old male presented to our institution's endocrine surgery clinic for evaluation of an enlarging right adrenal mass. This mass was incidentally found during an abdominal ultrasound performed for transaminitis and thrombocytopenia. Patient was asymptomatic without any abdominal discomfort, back pain, nausea, or vomiting. Results: Patient was lost to follow up until 2018. Follow-up computed tomography scan in 2018 showed the right adrenal mass measuring 12.3 cm in greatest dimension with significant macroscopic fat. Given the imaging features, AM was the presumed diagnosis. However, with a medical history of uncontrolled sickle cell disease, extra-medullary hematopoiesis and rapidly growing liposarcoma could not be ruled out. Surgical excision was performed due to size and significant tumor growth. Diagnosis was confirmed with histopathology and revealed myelolipoma. Conclusion: Image characteristics can be helpful in diagnosis of AM; however, the appearance of this lesion on computed tomography can be similar to other adrenal gland pathologies such as liposarcoma and mass-forming extramedullary hematopoiesis. Percutaneous needle biopsy may be indicated if the diagnosis remains unclear.

scholarly journals Rare metastases of differentiated thyroid carcinoma: pictorial review

2011 ◽  
Vol 18 (5) ◽  
pp. R165-R174 ◽  
Author(s):  
Hong-Jun Song ◽  
Yan-Li Xue ◽  
Yan-Hong Xu ◽  
Zhong-Ling Qiu ◽  
Quan-Yong Luo
Keyword(s):  
Computed Tomography ◽  
Clinical Decision Making ◽  
Single Photon ◽  
Photon Emission ◽  
Distant Metastases ◽  
Clinical Decision ◽  
Emission Computed Tomography ◽  
Imaging Features ◽  
Term Survival ◽  
Pictorial Review

Differentiated thyroid cancer (DTC) is usually indolent with good prognosis and long-term survival. However, DTC distant metastasis is often a grave event and accounts for most of its disease-specific mortality. The major sites of distant metastases are the lung and bone. Metastases to the brain, breast, liver, kidney, muscle, and skin are rare or relatively rare. Nevertheless, recognizing rare metastases from DTC has a significant impact on the clinical decision making and prognosis of patients. 131I single photon emission computed tomography/computed tomography (131I-SPECT/CT) can provide both metabolic and anatomic information about a lesion; therefore, it can better localize and define the 131I-WBS findings in DTC patients. In this pictorial review, the imaging features of a range of rare metastases from DTC are demonstrated, with a particular emphasis on the 131I-SPECT/CT diagnostic aspect.

scholarly journals Impact of Grade Groups on Prostate Cancer-Specific and Other-Cause Mortality: Competing Risk Analysis from a Large Single Institution Series

Cancers ◽  
2021 ◽  
Vol 13 (8) ◽  
pp. 1963
Author(s):  
Daimantas Milonas ◽  
Tomas Ruzgas ◽  
Zilvinas Venclovas ◽  
Mindaugas Jievaltas ◽  
Steven Joniau
Keyword(s):  
Clinical Decision Making ◽  
Area Under The Curve ◽  
Clinical Decision ◽  
Competing Risk ◽  
Grade Group ◽  
Tertiary Center ◽  
Stable Performance ◽  
Cancer Specific Mortality ◽  
Risk Of Cancer

Objective: To assess the risk of cancer-specific mortality (CSM) and other-cause mortality (OCM) using post-operative International Society of Urological Pathology Grade Group (GG) model in patients after radical prostatectomy (RP). Patients and Methods: Overall 1921 consecutive men who underwent RP during 2001 to 2017 in a single tertiary center were included in the study. Multivariate competing risk regression analysis was used to identify significant predictors and quantify cumulative incidence of CSM and OCM. Time-depending area under the curve (AUC) depicted the performance of GG model on prediction of CSM. Results: Over a median follow-up of 7.9-year (IQR 4.4-11.7) after RP, 235 (12.2%) deaths were registered, and 52 (2.7%) of them were related to PCa. GG model showed high and stable performance (time-dependent AUC 0.88) on prediction of CSM. Cumulative 10-year CSM in GGs 1 to 5 was 0.9%, 2.3%, 7.6%, 14.7%, and 48.6%, respectively; 10-year OCM in GGs was 15.5%, 16.1%, 12.6%, 17.7% and 6.5%, respectively. The ratio between 10-year CSM/OCM in GGs 1 to 5 was 1:17, 1:7, 1:2, 1:1, and 7:1, respectively. Conclusions: Cancer-specific and other-cause mortality differed widely between GGs. Presented findings could aid in personalized clinical decision making for active treatment.

scholarly journals Choice of faecal immunochemical test matters: comparison of OC-Sensor and HM-JACKarc, in the assessment of patients at high risk of colorectal cancer

2020 ◽  
Vol 0 (0) ◽  
Author(s):  
Caroline J. Chapman ◽  
Ayan Banerjea ◽  
David J Humes ◽  
Jaren Allen ◽  
Simon Oliver ◽  
...  
Keyword(s):  
Colorectal Cancer ◽  
Clinical Decision Making ◽  
Full Range ◽  
Clinical Decision ◽  
Detection Rates ◽  
Faecal Immunochemical Test ◽  
Specimen Collection ◽  
Increased Risk ◽  
Immunochemical Test

AbstractObjectivesCurrently, NICE recommends the use of faecal immunochemical test (FIT) at faecal haemoglobin concentrations (f-Hb) of 10 μg Hb/g faeces to stratify for colorectal cancer (CRC) risk in symptomatic populations. This f-Hb cut-off is advised across all analysers, despite the fact that a direct comparison of analyser performance, in a clinical setting, has not been performed.MethodsTwo specimen collection devices (OC-Sensor, OC-S; HM-JACKarc, HM-J) were sent to 914 consecutive individuals referred for follow up due to their increased risk of CRC. Agreement of f-Hb around cut-offs of 4, 10 and 150 µg Hb/g faeces and CRC detection rates were assessed. Two OC-S devices were sent to a further 114 individuals, for within test comparisons.ResultsA total of 732 (80.1%) individuals correctly completed and returned two different FIT devices, with 38 (5.2%) CRCs detected. Median f-Hb for individuals diagnosed with and without CRC were 258.5 and 1.8 µg Hb/g faeces for OC-S and 318.1 and 1.0 µg Hb/g faeces for HM-J respectively. Correlation of f-Hb results between OC-S/HM-J over the full range was rho=0.74, p<0.001. Using a f-Hb of 4 µg Hb/g faeces for both tests found an agreement of 88.1%, at 10 µg Hb/g faeces 91.7% and at 150 µg Hb/g faeces 96.3%. A total of 114 individuals completed and returned two OC-S devices; correlation across the full range was rho=0.98, p<0.001.ConclusionsWe found large variations in f-Hb when different FIT devices were used, but a smaller variation when the same FIT device was used. Our data suggest that analyser-specific f-Hb cut-offs are applied with regard to clinical decision making, especially at lower f-Hb.

Between a logic of disruption and a logic of continuation: Negotiating the legitimacy of algorithms used in automated clinical decision-making

2021 ◽  
pp. 136345932199674
Author(s):  
Rikke Torenholt ◽  
Henriette Langstrup
Keyword(s):  
Decision Making ◽  
Clinical Practice ◽  
Patient Reported Outcomes ◽  
Patient Involvement ◽  
Clinical Decision Making ◽  
Diagnostic Procedures ◽  
Clinical Decision ◽  
Patient Reported ◽  
Pro Tools

In both popular and academic discussions of the use of algorithms in clinical practice, narratives often draw on the decisive potentialities of algorithms and come with the belief that algorithms will substantially transform healthcare. We suggest that this approach is associated with a logic of disruption. However, we argue that in clinical practice alongside this logic, another and less recognised logic exists, namely that of continuation: here the use of algorithms constitutes part of an established practice. Applying these logics as our analytical framing, we set out to explore how algorithms for clinical decision-making are enacted by political stakeholders, healthcare professionals, and patients, and in doing so, study how the legitimacy of delegating to an algorithm is negotiated and obtained. Empirically we draw on ethnographic fieldwork carried out in relation to attempts in Denmark to develop and implement Patient Reported Outcomes (PRO) tools – involving algorithmic sorting – in clinical practice. We follow the work within two disease areas: heart rehabilitation and breast cancer follow-up care. We show how at the political level, algorithms constitute tools for disrupting inefficient work and unsystematic patient involvement, whereas closer to the clinical practice, algorithms constitute a continuation of standardised and evidence-based diagnostic procedures and a continuation of the physicians’ expertise and authority. We argue that the co-existence of the two logics have implications as both provide a push towards the use of algorithms and how a logic of continuation may divert attention away from new issues introduced with automated digital decision-support systems.

scholarly journals Multimodal imaging patterns predict survival in recurrent glioblastoma patients treated with bevacizumab

2016 ◽  
Vol 18 (12) ◽  
pp. 1680-1687 ◽  
Author(s):  
Ken Chang ◽  
Biqi Zhang ◽  
Xiaotao Guo ◽  
Min Zong ◽  
Rifaquat Rahman ◽  
...  
Keyword(s):  
Clinical Decision Making ◽  
Progression Free Survival ◽  
Clinical Decision ◽  
Recurrent Glioblastoma ◽  
Machine Learning Techniques ◽  
Imaging Biomarkers ◽  
Imaging Features ◽  
Mri Features ◽  
Fluid Attenuated Inversion Recovery ◽  
Multimodal Mri

Abstract Background Bevacizumab is a humanized antibody against vascular endothelial growth factor approved for treatment of recurrent glioblastoma. There is a need to discover imaging biomarkers that can aid in the selection of patients who will likely derive the most survival benefit from bevacizumab. Methods The aim of the study was to examine if pre- and posttherapy multimodal MRI features could predict progression-free survival and overall survival (OS) for patients with recurrent glioblastoma treated with bevacizumab. The patient population included 84 patients in a training cohort and 42 patients in a testing cohort, separated based on pretherapy imaging date. Tumor volumes of interest were segmented from contrast-enhanced T1-weighted and fluid attenuated inversion recovery images and were used to derive volumetric, shape, texture, parametric, and histogram features. A total of 2293 pretherapy and 9811 posttherapy features were used to generate the model. Results Using standard radiographic assessment criteria, the hazard ratio for predicting OS was 3.38 (P < .001). The hazard ratios for pre- and posttherapy features predicting OS were 5.10 (P < .001) and 3.64 (P < .005) for the training and testing cohorts, respectively. Conclusion With the use of machine learning techniques to analyze imaging features derived from pre- and posttherapy multimodal MRI, we were able to develop a predictive model for patient OS that could potentially assist clinical decision making.

Cardiac metastasis of osteosarcoma

Open Medicine ◽  
2010 ◽  
Vol 5 (5) ◽  
pp. 551-555
Author(s):  
Hilal Sahin ◽  
Naim Ceylan ◽  
Selen Bayraktaroglu ◽  
Recep Savas
Keyword(s):  
Computed Tomography ◽  
Case Report ◽  
Case Reports ◽  
Primary Tumour ◽  
Cardiac Metastasis ◽  
Imaging Findings ◽  
Cardiac Metastases ◽  
Enhanced Computed Tomography ◽  
Demographic Features

AbstractCardiac osteosarcoma metastasis is extremely rare and is documented in several case reports in the literature. The behaviour of osteosarcoma metastases is similar to the primary tumour. Thoracic non-enhanced computed tomography (CT) examination is beneficial in the detection of calcific cardiac metastases. In this case report, we describe a 29-year-old woman with cardiac osteosarcoma metastasis after 7 years of follow-up, compare the demographic features with previous cases and discuss the imaging findings.

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