Large, ulcerated infantile hemangioma of the chest wall complicated by life-threatening hemorrhage: Case report and literature review.

While ulceration is one of the most common infantile hemangioma (IH) complications, severe bleeding is a rare consequence, with a paucity of patients reported. We report a 5-month-old girl with a very large, mixed, partial segmental IH of the upper chest wall who, despite medical intervention, developed severe ulceration and multiple episodes of life-threatening bleeding that ultimately led to hemorrhagic shock. Experience in our patient and a review of six previous reports shows that severe bleeding is a risk when ulceration extends directly into an arterial feeding vessel that is often visible clinically.

Treatment of Systemic Sclerosis-associated Interstitial Lung Disease: Evidence-based Recommendations. An Official American Thoracic Society Clinical Practice Guideline.

Interstitial lung disease (ILD) is a significant cause of morbidity and mortality in patients with systemic sclerosis (SSc). To date, clinical practice guidelines regarding treatment for patients with SSc-ILD are primarily consensus based. An international expert guideline committee composed of 24 individuals with expertise in rheumatology, SSc, pulmonology, ILD, or methodology, and with personal experience with SSc-ILD, discussed systematic reviews of the published evidence assessed using the Grading of Recommendations, Assessment, Development, and Evaluation approach.

Antisynthetase syndrome-related interstitial lung disease (ASyS-ILD): longitudinal imaging findings.

Objectives: Interstitial lung disease (ILD) impacts mortality in antisynthetase syndrome (ASyS). Computed tomographic (CT) patterns and evolution in ASyS ILD are not well described. We report longitudinal CT patterns in ASyS-ILD and their impact on survival.

Sporadic inclusion body myositis and primary Sjogren's syndrome: an overlooked diagnosis.

Sporadic inclusion body myositis (sIBM) has been reported to occur in association with autoimmune diseases and in particular, primary Sjogren's syndrome (pSS). This brief report describes patients identified with a positive SSA antibody and diagnosis of sIBM at a large academic medical center over a 13.5-year period.

Polymyalgia Rheumatica: a Common Disease in Seniors.

Purpose Of The Review: Polymyalgia rheumatica (PMR) is one of the most common inflammatory rheumatologic condition occurring in older adults. It is characterized by proximal pain and stiffness in the shoulders, neck, and/or pelvic girdle in individuals over 50 years of age along with evidence of an intense systemic inflammatory response. Although the above clinical symptoms are very characteristic for the condition, it can be mimicked by other autoimmune, infectious, malignant, and endocrine disorders chief among which are giant cell arteritis (GCA) and elderly-onset rheumatoid arthritis (EORA).

A multidisciplinary approach to VA ECMO cannulation in children.

Purpose: Extracorporeal membrane oxygenation (ECMO) supports gas exchange and circulation in critically ill patients. This study describes a multidisciplinary approach to ECMO cannulation using the expertise of pediatric surgery (PS) and interventional radiology (IR).

Material And Methods: Pediatric patients (<18 years) undergoing percutaneous cannulation for peripheral veno-arterial (VA) ECMO by PS and IR from April 2017 to May 2018 were included.

Percutaneous Lung Biopsy in Immunocompromised Pediatric Patients.

Purpose: To determine the diagnostic yield and safety of image-guided lung biopsies in immunocompromised pediatric patients.

Materials And Methods: This was a retrospective pediatric cohort study conducted from June 2000 to April 2017. Subjects were 0-17 years of age (median, 10 years of age).

Use of Anakinra in Hospitalized Patients with Crystal-associated Arthritis.

Objective: In this retrospective observational study, we assess the efficacy and safety of the interleukin 1 receptor antagonist anakinra in medically complex, hospitalized patients with acute gout and calcium pyrophosphate crystal arthritis.

Methods: Adult inpatients treated with anakinra from 2014 to 2017 were identified for inclusion. Charts were reviewed for demographics, comorbidities, laboratory data, pain scores, joint involvement, prior treatment, dosing and response to anakinra, concurrent infections, and surgical interventions.

The Spatial Distribution of Late Gadolinium Enhancement of Left Atrial Magnetic Resonance Imaging in Patients With Atrial Fibrillation.

Objectives: The purpose of this study is to evaluate the spatial distribution of late gadolinium enhancement (LGE) of the left atrium (LA) by LGE-magnetic resonance imaging in an atrial fibrillation (AF) population.

Background: LGE of the LA can be a surrogate of pre-existing structural remodeling of LA.

Methods: LGE-magnetic resonance imaging scans were used for 160 patients with AF (mean age 66 ± 11 years) before AF ablation.

Exercise Capacity Correlates With Left Atrial Structural Remodeling as Detected by Late Gadolinium-Enhanced Cardiac Magnetic Resonance in Patients With Atrial Fibrillation.

Objectives: This study hypothesized that left atrial structural remodeling (LA-TR) correlates with exercise capacity (EC) in a cohort of patients with atrial fibrillation (AF).

Background: Late gadolinium-enhanced cardiac magnetic resonance (LGE-CMR) imaging provides a method of assessing LA-TR in patients with AF.

Methods: A total of 145 patients (32% female, mean age 63.

Pharmacologic Therapies for Rheumatologic and Autoimmune Conditions.

Disease-modifying antirheumatic drugs (DMARDs) are commonly prescribed by rheumatologists to reduce disease activity and induce remission in autoimmune conditions such as systemic lupus erythematosus and rheumatoid arthritis. Steroids are sometimes used in combination with DMARD therapy and should be used at the lowest effective dose for the least amount of time. There are many biologic agents available for use for inflammatory arthritis and other autoimmune conditions.

Quantitative and morphologic change associated with breast cancer-related lymphedema. Comparison of 3.0T MRI to external measures.

Unlabelled: Abstract Introduction: Lymphedema is a chronic disease of increasing importance to cancer survivors. A tape measurement tool used for lymphedema relies on indirect volume calculations based on external circumference, which may not reflect the true extent of abnormal fluid accumulation accurately. Fluid-sensitive MRI sequences may be able to delineate the severity of this condition more precisely and thus also monitor response to therapy.

A POINT-CORRESPONDENCE APPROACH TO DESCRIBING THE DISTRIBUTION OF IMAGE FEATURES ON ANATOMICAL SURFACES, WITH APPLICATION TO ATRIAL FIBRILLATION.

This paper describes a framework for summarizing and comparing the distributions of image features on anatomical shape surfaces in populations. The approach uses a point-based correspondence model to establish a mapping among surface positions and may be useful for anatomy that exhibits a relatively high degree of shape variability, such as cardiac anatomy. The approach is motivated by the MRI-based study of diseased, or , tissue in the left atrium of atrial fibrillation (AF) patients, which has been difficult to measure quantitatively using more established image and surface registration techniques.

Computational Shape Models Characterize Shape Change of the Left Atrium in Atrial Fibrillation.

Shape change of the left atrium (LA) and LA appendage in atrial fibrillation (AF) patients is hypothesized to be linked to AF pathology and to play a role in thrombogenesis; however, many aspects of shape variation in the heart are poorly understood. To date, studies of the LA shape in AF have been limited to empirical observation and summary metrics, such as volume and its likeness to a sphere. This paper describes a more comprehensive approach to the study of the LA shape through the use of computationally derived statistical shape models.

Treatment of acute gouty arthritis in complex hospitalized patients with anakinra.

Objective: To report our experience with the efficacy and safety of anakinra for acute gouty arthritis in medically complex hospitalized patients.

Methods: We reviewed the hospital charts of 26 patients treated with anakinra for crystal-induced arthritis since 2007. Demographics, comorbid conditions, reason for anakinra use, response to treatment, and any adverse outcomes were recorded.

Lipid-associated rheumatologic syndromes.

Rheumatologic manifestations of hyperlipidemia and lipid-associated arthritis are rarely seen in the rheumatologist's office. On the other hand, a rheumatologist may be the clinician who identifies and initiates proper therapy for disorders related to hyperlipidemia when the musculoskeletal manifestations of these syndromes are recognized. In this article both the joint and tendon manifestations are reviewed, including the lesser known lipid liquid crystal form of arthritis.

Perceptual analysis of the reading of dermatopathology virtual slides by pathology residents.

Context: The process by which pathologists arrive at a given diagnosis-a combination of their slide exploration strategy, perceptual information gathering, and cognitive decision making-has not been thoroughly explored, and many questions remain unanswered.

Objective: To determine how pathology residents learn to diagnose inflammatory skin dermatoses, we contrasted the slide exploration strategy, perceptual capture of relevant histopathologic findings, and cognitive integration of identified features between 2 groups of residents, those who had and those who had not undergone their dermatopathology rotation.

Design: Residents read a case set of 20 virtual slides (10 depicting nodular and diffuse dermatitis and 10 depicting subepidermal vesicular dermatitis), using an in-house-developed interface.

A survey of arthrocentesis and soft-tissue injection procedures performed in primary care practice: effect of resident training and using data to shape curriculum.

Objective: The purpose of this study is (1) to survey graduates of our internal medicine program for use of musculoskeletal (MSK) procedures in primary care practice and assess the influence of participating in a first-year resident arthrocentesis and soft-tissue injection training course on their MSK procedure comfort/utilization; and (2) to use the results to modify our MSK procedure curriculum.

Methods: A questionnaire designed to assess numbers of, comfort with, and effect of resident training on MSK procedures in the preceding year was sent to 2002-2006 graduates of the internal medicine training program in outpatient primary care (OPC). Graduates practicing hospital medicine (HM) also received the questionnaire and served as a comparison group.

Synapse elimination accompanies functional plasticity in hippocampal neurons.

A critical component of nervous system development is synapse elimination during early postnatal life, a process known to depend on neuronal activity. Changes in synaptic strength in the form of long-term potentiation (LTP) and long-term depression (LTD) correlate with dendritic spine enlargement or shrinkage, respectively, but whether LTD can lead to an actual separation of the synaptic structures when the spine shrinks or is lost remains unknown. Here, we addressed this issue by using concurrent imaging and electrophysiological recording of live synapses.