Colorectal Cancer Liver Metastases: Biopsy of the Ablation Zone and Margins Can Be Used to Predict Oncologic Outcome.

Purpose To establish the prognostic value of biopsy of the central and marginal ablation zones for time to local tumor progression (LTP) after radiofrequency (RF) ablation of colorectal cancer liver metastasis (CLM). Materials and Methods A total of 47 patients with 67 CLMs were enrolled in this prospective institutional review board-approved and HIPAA-compliant study between November 2009 and August 2012. Mean tumor size was 2.

Right ventricular outflow tract imaging with CT and MRI: Part 2, Function.

Objective: MRI and CT have become the ideal methods for assessing the complex function of the conotruncal region, including the right ventricular outflow tract (RVOT). In this review, we focus on the role of CT and MRI to evaluate RVOT function in relation to developmental malformations.

Conclusion: We discuss the role of imaging pertinent to electrophysiologic assessment for cardiac arrhythmias.

Right ventricular outflow tract imaging with CT and MRI: Part 1, Morphology.

Objective: MRI and CT have become the ideal methods for assessing the complex morphology of the conotruncal region, including the right ventricular outflow tract (RVOT). Detailed information about the embryology and anatomy of the RVOT provides a better understanding of the spectrum of diseases of this region and helps to narrow the differential diagnoses of abnormalities involving this important structure. In this review, we focus on the role of CT and MRI to evaluate morphology in relation to developmental malformation of the RVOT.

Microvascular decompression for intractable singultus: technical case report.

Objective: Intractable singultus is a rare but significantly disruptive clinical phenomenon that often accompanies other diseases but can present in isolation due entirely to intracranial pathology. We report a case of intractable singultus that improved after microvascular decompression and present a comprehensive review of singultus by discussing its similarity to other cases of microvascular decompression, its history and etiology, and its evolutionary basis.

Clinical Presentation: The patient exhibited intractable singultus for 15 years, resistant to multiple medical regimens.

Change in practice patterns of an academic division of vascular surgery.

Hypothesis: Technological advances have required that faculty of academic divisions of vascular surgery acquire new technical skills and significantly alter their past clinical practice patterns.

Design: Retrospective medical record review.

Setting: An academic tertiary referral center and a community teaching hospital.

Extended pancreatectomy with resection of the celiac axis: the modified Appleby operation.

Background: Celiac axis invasion by central and distal pancreatic cancers has been considered a contraindication to resection. Appleby first described en-bloc celiac axis resection with total gastrectomy for locally advanced gastric cancer. We present our experience with a modification of this procedure in central pancreatic cancers involving the celiac trunk.

Transfusion free surgery: single institution experience of 27 consecutive liver transplants in Jehovah's Witnesses.

Background: Despite the risks associated with transfusion, the medical community continues to view blood as a safe and abundant product. In this article, we provide an effective strategy to accomplish orthotopic liver transplantation without transfusion.

Study Design: From June 1999 through July 2004, 27 liver transplantations were performed in Jehovah's Witness patients at the USC-University Hospital (24 adults, 3 children).

Major hepatobiliary surgery during pregnancy: safety and timing.

Hepatobiliary disease, although rare, may present during pregnancy with potential complications for mother and fetus. We present two cases of choledochal cysts and one case of a hepatic adenoma diagnosed in gravid patients. All three patients had acute events or failed medical management and were successfully treated with open resection, excision, or reconstruction during the second or third trimesters of pregnancy without requiring blood transfusions or tocolytic therapy.

Diagnosis and management of iliac vein compression syndrome.

Iliac vein compression syndrome (IVCS) is the most probable cause of iliofemoral deep venous thrombosis (DVT). One half to two thirds of patients with left-sided iliofemoral DVT have intraluminal webs or spurs from chronic extrinsic compression of the left iliac vein at the crossing point of the right common iliac artery. Approximately 2% to 5% of those with chronic deep venous insufficiency of the left leg may have IVCS.

Management of an abdominal aortic aneurysm in a patient with end-stage liver disease.

Concomitant abdominal aortic aneurysms and cirrhosis that need surgical attention are rare. Currently there are no guidelines with regards to the appropriate timing of the repair of these aneurysms and transplantation. In addition it also raises the issue of which procedure takes precedence.

Imaging of the pituitary and parasellar region.

The pituitary is part of a chain of enormous biologic amplification, which is regulated by a small amount of releasing factors in the portal blood from the hypothalamus. The pituitary is a master gland that regulates a number of hormones. A subtle abnormality in the pituitary can cause significant changes in body metabolism.

The differential effects of fatigue on reflex response timing and amplitude in males and females.

We examined the effects of fatigue on patellar tendon reflex responses in males and females. A spring-loaded reflex hammer elicited a standardized tendon tap with the knee positioned in an isokinetic dynamometer and flexed to 85 degrees. We recorded vastus lateralis activity (SEMG) and knee extension force production at the distal tibia (force transducer).

Lipoma arborescens: high-resolution ultrasonographic findings.

Three patients with lipoma arborescens of the knee joint were evaluated with high resolution ultrasonography. All patients demonstrated a hyperechoic, frondlike mass in the suprapatellar bursa with a large associated effusion. All had popliteal cyst formation without involvement by the mass.

Modern metal on metal articulation for total hip replacements.

Between 1991 and 1994, 70 patients received total hip replacements with metal on metal articulation. The results of 54 of these patients with 54 hips who have a 2- to 4-year (2.7-year average) followup are reported.

Rehabilitation after total knee arthroplasty: a comparison of 2 rehabilitation techniques.

This study was conducted to compare postoperative total knee arthroplasty rehabilitation protocols. The hypothesis of this study was that patients undergoing total knee arthroplasty could achieve range of motion and hospital discharge in the same period using a postoperative rehabilitation protocol that did not use a continuous passive motion machine. This randomized prospective study compared 46 total knee arthroplasties in which a continuous passive motion machine was used with 37 total knees that were rehabilitated with early passive flexion of the knee (named drop and dangle protocol).

Saline MR peritoneography.

Objective: Our objective was to describe a new method for the evaluation of peritoneal surfaces in patients with intraperitoneal carcinomatosis and sarcomatosis.

Conclusion: Fast spin-echo T2-weighted imaging in conjuction with intraperitoneally instilled saline permits detailed evaluation of peritoneal surfaces, omentum, and mesenteries. The detection of tumor implants is facilitated by their visualization against the saline background.

Long-term results of cemented total hip arthroplasty in patients 45 years old or younger. A 16-year follow-up study.

Forty-nine cemented total hip arthroplasties in patients younger than 45 years were reviewed, with an average follow-up period of 16.2 years. The results were compared with the same group previously reported at average follow-up periods of 4.

Breakage of a Total Condylar III knee prosthesis. A case report.

The authors report the failure of a Total Condylar III (Cintor, Johnson and Johnson, Raynham, MA) knee arthroplasty, implanted in a second revision knee surgery, due to fracture of the tibial spine. The tibial component was in varus position and externally rotated relative to the tibia. This imparted torque and resulted in a spiral fracture of the polyethylene spine.

Candida thrombosis of the innominate vein with septic pulmonary emboli.

Thrombosis of central veins has become more prevalent because of increased use of long-term central venous catheterization. Candida superinfection of the thrombus can occur particularly in patients on long-term antibiotic therapy and on parenteral nutrition. Removal of the catheter, thrombolytic therapy, anticoagulation, and antifungal therapy with amphotericin B will usually eradicate the candidemia and restore venous patency.