Rapid Acute Coronary Syndrome Evaluation Over One Hour With High-Sensitivity Cardiac Troponin I: A United States-Based Stepped-Wedge, Randomized Trial.

Study Objective: The real-world effectiveness and safety of a 0/1-hour accelerated protocol using high-sensitivity cardiac troponin (hs-cTn) to exclude myocardial infarction (MI) compared to routine care in the United States is uncertain. The objective was to compare a 0/1-hour accelerated protocol for evaluation of MI to a 0/3-hour standard care protocol.

Methods: The RACE-IT trial was a stepped-wedge, randomized trial across 9 emergency departments (EDs) that enrolled 32,609 patients evaluated for possible MI from July 2020 through April 2021.

Breast implant-associated anaplastic large cell lymphoma with contralateral invasive lobular carcinoma.

Breast implant-associated anaplastic large cell lymphoma (BIA-ALCL) is a rare type of T-cell lymphoma that arises in the setting of textured breast implants. In this case report, a 69-year-old woman with a remote history of right-sided invasive lobular carcinoma status post right mastectomy and bilateral breast reconstruction presents with spontaneous right breast swelling and pain, suspicious for implant rupture. Diagnostic MRI revealed a peri-implant fluid collection in the right breast and focal nonmass enhancement in the left breast.

The Radiologist's Role in a Breast Multidisciplinary Tumor Board.

Breast multidisciplinary tumor boards (MTBs) play an important role in determining treatment. This article serves as a guide for the radiologist participating in a breast MTB, as the information presented at MTB can significantly influence treatment plans and dictate future steps for further patient work-up. Multidisciplinary tumor board preparation involves a careful review of the patient's history while gathering all relevant imaging studies, and reinterpreting them when appropriate.

Low-dose Carbicarb improves cerebral outcome after asphyxial cardiac arrest in rats.

Study Objective: Controversy surrounds the use of buffers during cardiac arrest to correct acidosis. The objective of this study was to determine whether attenuation or neutralization of cerebral acidosis by Carbicarb alters hippocampal glutamate levels, neuronal cell death, and neurologic deficits after reperfusion from asphyxial cardiac arrest in rats.

Methods: Rats were prospectively randomized to either a control (n=45), low-dose Carbicarb (LDC; 3 mL/kg, n=45), or high-dose Carbicarb (HDC; 6 mL/kg, n=45) group in a blinded fashion during resuscitation after 8 minutes of asphyxial cardiac arrest.

Calcification as a sign of sarcomatous degeneration of malignant pleural mesotheliomas: a new CT finding.

We present two cases demonstrating, on CT examination, heavily calcified mass lesions associated with malignant pleural mesothelioma in workers occupationally exposed to asbestos. These masses proved to be osteogenic sarcomatous degeneration within mesotheliomas. The observation of dense calcification within a pleural mass should raise a suspicion of osteosarcomatous degeneration if it is seen in conjunction with other classic signs of malignant pleural mesothelioma.

The shooting of President Reagan: a radiologic chronology of his medical care.

Radiography of the chest played a central role in the care of President Ronald Reagan who, in 1981, became the only president of the United States to survive being struck by a would-be assassin's bullet. These radiographs not only illustrate the medical events that followed the gunshot wound to the president's chest, but also provide graphic documentation of the president's medical care, suspected complications, and recovery following this near-fatal wound. This report constitutes the only complete pictorial record of the care of President Reagan during that historic episode.

The attempted assassination of President Reagan. Medical implications and historical perspective.

In 1981, President Ronald Reagan became the first incumbent president of the United States to survive being struck by a would-be assassin's bullet. Had President Reagan not survived, the history of this country and the world most certainly would have been changed. This report is the only first-hand account of the details of his medical care and complications following the assassination attempt, an event that emphasizes the vulnerability of presidents to would-be assassins and the importance of readily available expert medical care and facilities to their survival.

Perinephric panniculitis.

Panniculitis is an inflammatory condition of adipose tissue that is mainly seen subcutaneously or intra-abdominally. There have been rare case reports of retroperitoneal involvement but no reported cases of perinephric panniculitis. To our knowledge we report the first documented case of perinephric panniculitis.

Tension pyopneumothorax. Rare presentation of ruptured Barrett's esophagus.

Tension pneumothorax following esophageal rupture is very rare. We report a case in which a perforated Barrett's esophagus rapidly developed a spontaneous tension pyopneumothorax. The mechanism for the tension remains obscure.

Diagnosis of paraesophageal omental hiatal hernia by magnetic resonance imaging.

We present a case of an enlarging retrocardiac mass lesion in which we observed the magnetic resonance imaging (MRI) finding of a fatty tumor with contiguous blood vessels extending from the abdominal portion into the thoracic portion of the tumor. These surgically verified findings provide an MRI indication of the presence of a paraesophageal omental hiatal hernia.

Sterile mediastinal gas mimicking abscess in aortic aneurysm repair.

Six weeks after aortic aneurysm repair, computed tomography (CT) showed mediastinal gas where absorbable gelatin sponge (Gelfoam) was used. A leukocyte scan labeled with indium 111, however, was normal and surgical exploration showed no infection. Sterile gas collections may be seen following absorbable gelatin sponge use many weeks after surgery and 111In-labeled leukocyte scanning may be a useful differential test.

Vitamin K supplementation during prophylactic use of cefoperazone in urologic surgery.

Cefoperazone, an antibiotic commonly used for prophylaxis of infection, has been associated with hypoprothrombinemia and bleeding. To reduce the risk of bleeding, co-administration of vitamin K has been advised. We reassessed the need for vitamin K use in a retrospective analysis of 50 patients undergoing urologic procedures and who had received cefoperazone for three days to prevent infection.

Noninvasive detection of early asbestos-related disease of the thorax: algorithmic analysis of radiographic, nuclear, and serologic tests.

Improved imaging techniques may assist in the diagnosis of early asbestosis, such as could occur from "asbestos in place." These include (1) increased visualization of visceral pleural thickening, (2) high-resolution computed tomography (HRCT), and (3) gallium scanning, combined with evidence of serum markers indicating inflammation-associated pulmonary collagen formation. Combining these imaging and serum test observations with a clinically useful algorithmic approach may permit the diagnosis of "early" asbestosis, which is not now possible from the individual test results or from an unweighted combination of such data.

A clinical diagnostic model for the assessment of asbestosis: a new algorithmic approach.

Asbestosis, one of the pneumoconioses that is defined by a set of clinical, radiographic, and pathologic findings, occurs as a result of exposure to asbestos fibers. Several approaches have attempted to describe the presence, progression, or extent of asbestosis. However, these approaches have attempted to describe the presence, progression, or extent of asbestosis.

The radiographic pleural abnormalities in asbestos exposure: relationship to physiologic abnormalities.

The effects of asbestos-induced benign pleural conditions on pulmonary function have been controversial since this subject was first studied in the mid-1960s. Firm conclusions have been difficult to reach because of (1) the difficulty of taking into account asbestos exposure, which may have effects on pulmonary function other than those mediated through pleural lesions, (2) the disagreement over the type and extent of radiographic pleural abnormalities, (3) the imprecision in measuring pulmonary function, and (4) the numerous potential confounding factors of reduced pulmonary function, such as cigarette smoking, age, concurrent occupational exposures, and prior chest diseases or trauma. This article critically evaluates the published reports on the functional significance of asbestos-induced pleural conditions.

Roentgenographic underestimation of early asbestosis by International Labor Organization classification. Analysis of data and probabilities.

We analyzed the limitations of the International Labor Organization (ILO) classification of chest roentgenograms in predicting the presence of histologically determined early asbestosis. The ILO system is arbitrary, without histologic correlates, and does not consider the asbestos exposure history or clinical and laboratory information. We present data from the literature and our own work which demonstrate that the application of the ILO classification to an asbestos-exposed individual can result in a 10 to 20 percent probability of a "normal" roentgenographic interpretation in the presence of significant asbestosis at the histologic level, leading to an inappropriate conclusion regarding the presence of asbestosis.

CT demonstration of interlobar fissure calcification due to asbestos exposure.

This is the second report of calcification of the major fissure in asbestos-related pleural disease and the first in which CT was necessary to visualize its presence. This case illustrates that CT may have an additional important use in the radiologic evaluation of individuals who have had asbestos exposure.

Visceral pleural thickening in asbestos exposure: the occurrence and implications of thickened interlobar fissures.

We evaluated fissural (ie, visceral pleural) thickening on radiographs in two asbestos-exposed study populations and a control group. Asbestos workers had an incidence of fissural thickening of 54.5% compared with 16.

Kaposi's sarcoma of the lung in AIDS: radiologic-pathologic analysis.

Kaposi's sarcoma in patients with AIDS involves the lung more often than it does in the African form of the neoplasm. This article describes the radiographic and histologic features in nine cases of pulmonary Kaposi's sarcoma, uncomplicated by infection, and reviews the radiographic descriptions of 22 similar cases from the literature. Pulmonary parenchymal disease in reported cases and in this series was usually diffuse.

Benign schwannomas: pathologic basis for CT inhomogeneities.

Four cases of pathologically proven benign schwannoma were reviewed and the histology was compared with the CT appearance. Each tumor was of mixed CT attenuation, which has been thought to be an indication of malignancy. The areas of inhomogeneity on CT in these cases may relate pathologically to confluent areas of hypocellularity adjacent to densely cellular or collagenous regions, xanthomatous change, and/or regions of cystic degeneration.