Clinicopathological characteristics and prognosis of gastrointestinal stromal tumors containing air-fluid levels

An air-fluid level within a gastrointestinal stromal tumor (GIST) is unusual and indicates the presence of a fistula within the lumen of the GI tract. Until recently, the optimal management of such patients was not clear-cut. This retrospective study investigated the clinicopathological characteristics, surgical procedures, pre-and post-operative management, and prognosis of patients with GIST containing an air-fluid level. Data of GIST patients, spanning 5 years, including 17 GIST patients with air-fluid levels in the experimental group and 34 GIST patients without air-fluid levels in the control group, were retrieved from two hospitals in China. The clinicopathological characteristics, types of surgery, management, and clinical outcomes of GIST patients were compared between the two groups. GISTs containing air-fluid levels were significantly different from GISTs without air-fluid levels regarding tumor morphology, NIH risk category, invasion of adjacent organs, and necrosis or ulceration. Most GIST patients with air-fluid levels (14/17, 82.4%) received open surgery, significantly higher than the 20.6% in the control group. Targeted therapy with Imatinib mesylate (IM) was implemented in all GIST patients in the experimental group (17/17, 100%); markedly higher than those (3/34, 8.8%) in the control group. During follow-up, recurrence and death rates (5.9% and 5.9%) in the experimental group were higher than those (2.9% and 0%) in the control group. Open surgery is commonly performed in GIST patients with air-fluid levels who also require targeted therapy with IM. The Torricelli-Bernoulli sign could be a risk factor, adversely affecting the patient’s prognosis.

Cyst Type Differentiates Rathke Cleft Cysts From Cystic Pituitary Adenomas

PurposeA classification system for cystic sellar lesions does not exist. We propose a novel classification scheme for these lesions based on the heterogeneity of the cyst wall/contents and the presence of a solid component on imaging.MethodsWe retrospectively reviewed 205 patients’ medical records (2008–2020) who underwent primary surgery for a cystic sellar lesion. Cysts were classified a priori into 1 of 4 cyst types based on the heterogeneity of the cyst wall/contents and the presence of a solid component imaging. There was high interrater reliability. Univariable and multivariable models were used to estimate the ability of cyst type to predict the two most common diagnoses: Rathke cleft cyst (RCC) and cystic pituitary adenoma.ResultsThe frequencies of RCC and cystic pituitary adenoma in our cohort were 45.4% and 36.4%, respectively. Non-neoplastic lesions (e.g., arachnoid cysts and RCC) were more likely to be Type 1 or 2, whereas cystic neoplasms (e.g., pituitary adenomas and craniopharyngiomas) were more likely to be Type 3 or 4 (p<0.0001). Higher cyst types, compared to Type 1, had higher odds of being cystic pituitary adenomas compared to RCCs (OR: 23.7, p=0.033, and 342.6, p <0.0001, for Types 2 and 4, respectively). Lesions with a fluid-fluid level on preoperative MRI also had higher odds of being pituitary adenomas (OR: 12.7; p=0.023). Cystic pituitary adenomas were more common in patients with obesity (OR: 5.0, p=0.003) or symptomatic hyperprolactinemia (OR: 11.5; p<0.001, respectively). The multivariable model had a positive predictive value of 82.2% and negative predictive value of 86.4%.ConclusionWhen applied to the diagnosis of RCC versus cystic pituitary adenoma, higher cystic lesion types (Type 2 & 4), presence of fluid-fluid level, symptomatic hyperprolactinemia, and obesity were predictors of cystic pituitary adenoma. Further validation is needed, but this classification scheme may prove to be a useful tool for the management of patients with common sellar pathology.

SIGHT-GLASS DEGRADATION IN UREA CARBAMATE SOLUTION

In the industrial environment, a sight glass acts as a gauge for the fluid level in a pressure vessel. Sight glass must have the following physical properties: clarity (clear enough to view the fluid in the vessel), hardness (not easily broken), thermal shock resistance, and corrosion resistance. A historical investigation of the equipment placed in the High-Pressure Decomposer (HPD) unit of the Urea Plant-X and Plant-Y has a pressure of 17 Bar and a temperature of 124-155oC, yielded an analysis of sight glass degradation in carbamate solution. The sight glass that was installed is soda-lime fused glass. The average is based on the equipment's history.

Fuel Planning Errors in General Aviation from 2015 to 2020

BACKGROUND: Planning, whether preflight or in-flight, is a cause of accident that is presumably almost entirely preventable. Planning skills on the part of the pilot should assist in avoiding dangerous situations with regards to light conditions, weather, fuel shortage, and/or improper weight and balance. Fuel planning is noted as especially unnecessary, as fuel planning is not considered a complex skill but part of proper flight preparation and in-flight planning.METHODS: A total of 196 accident reports from 2015 until 2020 were extracted from the NTSB online database in which the probable cause included either preflight or in-flight planning as a cause attributed to the pilot. Of those accidents, the majority (N = 131, 67%) were attributed to fuel planning and were further analyzed.RESULTS: Fuel-planning related accidents were significantly less often fatal compared to all planning-related accidents and all fuel-related accidents. The majority of fuel planning accidents resulted in fuel exhaustion. Additionally, the cause attributed to the accidents was frequently the skill-based error of “fuel planning (pilot)” and the crew resource management issue of “fuel-fluid level”. Specific information regarding the pilot’s fuel plan was only available in 52 (40%) of the accident reports.CONCLUSIONS: The frequency of fuel-related planning accidents suggests that this aspect of pilotage is underestimated and requires more attention both in training and in standard operating procedures. In particular, more detailed information regarding the pilot’s fuel plan is necessary in order to determine which step in the process most frequently results in an accident.Kalagher H. Fuel planning errors in general aviation from 2015 to 2020. Aerosp Med Hum Perform. 2021; 92(12):970–974.

An extrahepatic hydatid cyst with the fat-fluid level

A hydatic cyst is a zoonosis caused by the larva of a tapeworm Echinococcus granulosus. The liver is the most commonly affected organ. Soft tissue localization has been reported in 2.3% of cases. Herein, we present a patient with a fat-containing hydatid cyst located in the left thigh. There are only a few reports in the literature on the presence of the fat-fluid level within a hydatid cyst. Previous studies have suggested that fat-containing hydatid cysts occur due to their cysto-biliary communication in the liver. In our case, we describe a fat-containing hydatid cyst in the extrahepatic location and discuss the pathophysiologic mechanism of fat inside it.

P.146 Non-contrast CT markers of intracerebral hemorrhage expansion: a predictive accuracy and reliability study

Background: We evaluated (1) the predictive accuracy and (2) multi-observer reliability of non-contrast CT markers of hematoma expansion (HE). Methods: In 124 patients with spontaneous intracerebral hemorrhage, two investigators documented the presence of six density (Barras density, hypodensity, black hole, swirl, blend, fluid level) and three shape (Barras shape, island, satellite) expansion markers, with discrepancies resolved by a third rater. We defined HE as any one of (1) >6 mL absolute or >33% relative growth of the intraparenchymal hematoma or (2) an absolute growth of >1 mL or new development of intraventricular hematoma. A subsample of 60 patients was used for the inter-observer reliability study in 13 raters. Seven raters participated in the intra-rater study. Results: The sensitivity of markers for HE varied between 4% (fluid level) and 78% (satellite), while specificity ranged from 37% (swirl) to 97% (black hole). Almost perfect inter-rater agreement was observed for the swirl (0.89) and fluid level (0.83) markers, while hypodensity (0.65) showed substantial agreement. Only the blend and fluid level markers achieved substantial intra-rater agreement (> 0.6) in all raters. Conclusions: Non-contrast CT markers of HE showed lower reliability and predictive accuracy than previously reported. Future studies should address means to improve NCCT-based HE prediction.