Endoscopic ultrasound and pancreatic applications: what the radiologist needs to know

As the technology has improved, endoscopic ultrasound (EUS) has taken on an important role in the diagnosis of a number of different neoplastic and non-neoplastic pancreatic diseases. EUS can provide high-resolution images with subtle anatomic detail, and has also taken on an important role in the targeted biopsy of the pancreas and adjacent structures. This review seeks to familiarize radiologists with the role of EUS in the diagnosis of chronic and autoimmune pancreatitis, solid pancreatic masses, and cystic pancreatic neoplasms.     

MR staging of anal cancer: what the radiologist needs to know

Abdominal Radiology - Anal canal cancer is a rare disease and squamous cell carcinoma is the most common histologic subtype. Traditionally, anal cancer is imaged with CT and PET/CT for purposes of...     

Combined hepatocellular-cholangiocarcinoma: what the radiologist needs to know about biphenotypic liver carcinoma

Combined hepatocellular-cholangiocarcinoma (CHC), also referred to as primary liver carcinoma (PLC) with biphenotypic differentiation, is an increasingly recognized subtype of malignant PLC encompassing varying morphologic forms thought to arise either from progenitor cell lineage or dedifferentiation of mature liver cells. Tumor cells express both biliary and hepatocellular markers by immunohistochemistry, and may also express progenitor cell and stem cell markers. Due to the relative rarity of this tumor type, little is known about the risk factors, imaging appearance, or prognosis. Few studies have demonstrated risk factors that overlap with hepatocellular carcinoma (HCC) and cholangiocarcinoma (CC), though not all appear to arise in the background of cirrhosis. The imaging appearances of these tumors may overlap with those of HCC and CC and discriminating features such as classic enhancement patterns and biliary ductal dilation are not universally present. Serum tumor markers, such as alpha-fetoprotein and carbohydrate antigen 19-9, may be helpful when they are discordant with imaging or if both are elevated to a significant degree. In regards to management and prognosis, most studies demonstrate worse outcomes compared with HCC or CC. In the United States, the diagnosis of HCC is frequently made with imaging alone, and subsequent management decisions, including organ allocation for transplantation, rely upon the radiological diagnosis. Given the importance of radiological diagnosis, awareness of this tumor type is essential for appropriate management.     

What the internist needs to know about infertility

Primary care physicians can manage two thirds of cases of suspected infertility. Assisted reproductive technology can help in many cases of pelvic adhesive disease, although the effectiveness of these procedures declines significantly with patient age. Testing for ovarian reserve is an important first step for many patients who are considering infertility treatment. Some causes of infertility are associated with significant medical problems such as diabetes and abnormal lipids; these should be assessed and a long-term management plan implemented.     

Imaging of endoscopic cystogastrostomy in pancreatic walled-off necrosis: what the radiologist needs to know

Abdominal Radiology - Acute pancreatitis is a frequent entity encountered by radiologists. In 2012, the Atlanta criteria were revised to help radiologists use a common nomenclature when describing...     

What every emergency nurse needs to know about aspirin

As the most commonly recommended medication in the world, aspirin is a medication with which emergency nurses are intimately familiar. Although this medication has been used for more than a century, health-care researchers are discovering new information about the utility of aspirin every year. Within this paper, we provide a review of recent findings related to the use of aspirin in the Emergency Department. In particular, we focus on understanding the pharmacokinetics of the medication as several drugs introduced in the past decade, interact with aspirin and create side effects harmful to patients. As well, we highlight current research around optimal dosage and other issues related to aspirin administration. This review is timely as several issues have arisen in the literature, in relation to the effectiveness of aspirin as an anti-platelet agent.     

What the radiologist needs to know: the role of preoperative computed tomography in selection of operative approach for adrenalectomy and review of operative techniques

Adrenalectomy is the standard of care for management of many adrenal tumor types and, in the United States alone, approximately 6000 adrenal surgeries are performed annually. Two general approaches to adrenalectomy have been described; (1) the open approach, in which a diseased adrenal is removed through a large (10–20 cm) abdominal wall incision, and (2) the minimally invasive approach, in which laparoscopy is used to excise the gland through incisions generally no longer than 1–2 cm. Given these disparate technique options, clear preoperative characterization of those specific disease features that inform selection of adrenalectomy approach is critically important to the surgeon. Because most of these features are directly assessed via preoperative abdominal imaging, in particular computed tomography (CT) scanning, a clear mutual understanding among surgeons and radiologists of those adrenal tumor features impacting operative approach selection is vital for planning adrenal surgery. In this context, we review the preoperative CT imaging features that specifically inform adrenalectomy approach selection, provide illustrative examples from our institution’s imaging and surgical archives, and provide a stepwise guide to both the open and laparoscopic adrenalectomy approaches.