Lesion-based Patterns of Morbidity and Mortality in Hospitalized Adolescents with Congenital Heart Disease

Objective: The objective of this analysis is to describe the characteristics and morbidity during hospitalizations among adolescents with congenital heart disease (AdoCHD) from the Pediatric Health Information System (PHIS) database. Methods: The PHIS database was queried for all AdoCHD admissions aged 12–18 years (1/1/2004–12/31/2013). Major forms of CHD were identified by their International Classification of Diseases, ninth revision codes, further verified based on their secondary diagnosis and/or procedure codes. Patient characteristics, diagnoses, procedures and vital status were assessed. Results: In total, there were 4,267 adolescents admitted to 42 Children’s Hospitals, 58.3% were males, 24.6% single ventricle (SV) patients, 64.1% bi-ventricle (BV), and 11.3% could not be classified. They accounted for 8,512 hospitalizations (41,240 total hospital days), of which 31.6% were intensive care unit (ICU) stays. ICU stay was similar for the SV and BV patients with similar duration of mechanical ventilation between the two groups. Overall, the most common CHD among in-patients was tetralogy of Fallot (TOF, 36.4%). Larger proportion of the BV AdoCHD admissions were for elective surgical and electrophysiological procedures. There were 109 (2.5%) heart transplantations (1.3% SV vs. 0.6% BV) and 120 in-hospital deaths (2.8%) (1.1% SV vs. 1.3% BV). Hypoplastic left heart syndrome was the most common diagnosis in transplanted patients (46%) and those who died (28%); TOF (29%) was frequent in 91 (2.1%) patients who had cardiac arrests. Conclusions: Different hospitalization patterns exist for BV and SV AdoCHD. Recognizing this risk may encourage directing resources toward optimizing long-term care of CHD patients.     

Rare cause of postoperative acute abdominal pain: Giant omental infarct later complicated by colonic fistulization

Omental infarction is caused by vascular obstruction with resulting tissue ischemia, representing a rare cause of abdominal pain. It has been described as a rare complication of gastric bypass. It is important to recognize omental infarction and its possible complications as The management is usually conservative with surgery deferred to specific cases. We present the case of a 56-year-old male with a history of gastric adenocarcinoma who underwent esophagogastrectomy with Roux-n-y reconstruction and 3 months later presented with severe persistent abdominal pain, due to a path proven giant omental infarction. Patient later was complicated with a colonic fistula to the omentum.     

Association between hereditary hemochromatosis and hepatocellular carcinoma: a comprehensive review

Hepatocellular carcinoma (HCC) is a significant global health problem with high morbidity and mortality. Its incidence is increasing exponentially worldwide wit...     

Pictorial essay: multimodality imaging of metastases from pancreatic ductal adenocarcinoma

Surgical resection is the only curative therapy available for pancreatic ductal adenocarcinoma. Unfortunately, metastatic disease constitutes an absolute contraindication for surgery. Therefore, the detection of metastatic disease is a critical component of preoperative imaging of pancreatic adenocarcinoma. Computed tomography and magnetic resonance imaging are currently used for the preoperative evaluation of these patients. Positron emission tomography/computed tomography and ultrasonography may also be helpful in the detection of metastatic disease. This pictorial essay reviews the imaging findings of common and uncommon metastases from pancreatic adenocarcinoma.     

Noncontrast 3D steady state free precession magnetic resonance angiography of the thoracic central veins using nonselective radiofrequency excitation over a large field of view: initial experience

PURPOSE: To evaluate the feasibility of three-dimensional (3D) steady state free precession (SSFP) magnetic resonance angiography (MRA) using nonselective radiofrequency excitation for the assessment of thoracic central veins. MATERIALS AND METHODS: Thirty consecutive patients (17 males, 13 females, age range 22-76) with various cardiac and thoracic vascular diseases underwent free-breathing electrocardiogram-gated noncontrast SSFP MRA and conventional high-resolution 3D contrast-enhanced (CE) MRA of the thorax at 1.5 T. Two readers evaluated both datasets for findings: venous visibility and sharpness (from 0, not visualized to 3, excellent definition); artifacts; signal-to-noise ratio (SNR); and contrast-to-noise ratio (CNR) in 8 venous segments including superior vena cava (SVC), supra-diaphragmatic inferior vena cava, bilateral brachiocephalic, proximal subclavian, and lower internal jugular veins. Statistical analysis was performed using Wilcoxon test for overall image quality and vessel visibility, t test for SNR and CNR analysis, and kappa coefficient for inter-observer variability. RESULTS: 3D SSFP and CE-MRA were successfully performed in all patients. Scan time for SSFP MRA ranged from 5 to 10 minutes (mean +/- standard deviation, 7 +/- 2 minutes). Reader 1 (2) graded the overall image quality as excellent and good on SSFP MRA in 23 (25) and 7 (5) patients, and on CE-MRA in 22 (23) and 8 (9) patients, respectively. On SSFP MRA, readers 1 and 2 graded 234 (97.5%) and 233 (97.1%) venous segments with diagnostic definition (grades 2 and 3) (kappa = 0.69), respectively. On conventional CE-MRA, readers 1 and 2 graded 231 (96.3%) and 232 (96.7%) venous segments with diagnostic definition (grades 2 and 3) (kappa = 0.68), respectively. Segmental visibility and sharpness were higher for lower internal jugular veins on CE-MRA for each reader (P < 0.001). No significant difference existed for venous visibility and sharpness scores for other venous segments between the 2 techniques for both readers (P > 0.05). SNR and CNR values were lower for internal jugular veins on SSFP MRA (P < 0.001). No significant difference existed between SNR and CNR values for the other venous segments on SSFP and CE-MRA (P > 0.05 for all). The 2 readers demonstrated patent SVC Glenn shunt to main pulmonary artery (n = 3), patent extra cardiac Fontan shunt from inferior vena cava to pulmonary artery confluence (n = 2), and dilatation and thrombosis of SVC (n = 1) and right brachiocephalic vein (n = 1) on both datasets. CONCLUSION: Free breathing navigator-gated noncontrast 3D SSFP MRA with nonselective radiofrequency excitation provides high image quality and sufficient SNR and CNR for confident evaluation of thoracic central veins.     

The age distribution,rates, and types of surgery for pelvic organ prolapse in the USA

The objective of this study was to describe the distribution of pelvic organ prolapse (POP) surgery across age groups in the USA in 2003. Patients were grouped into four age categories: Reproductive age, perimenopausal, postmenopausal, and elderly. Data from the 2003 National Hospital Discharge Survey and National Census were used to estimate surgical rates by age group. In 2003, 199,698 women underwent a total of 311,587 surgical procedures for POP. Prolapse surgical rates (per 10,000 women) were 7, 24, 31, and 17 in reproductive age, perimenopausal, postmenopausal, and elderly age groups, respectively. Surgical complications occurred in 28.8, 19.6, 18.6, and 22.1% of women in these age groups, respectively. Mortality was uncommon. Although often considered a condition of the elderly, this study suggests that pelvic organ prolapse is a condition affecting women across the reproductive life cycle and for which women of all ages seek surgical treatment. Presented at the annual meeting of the American Urogynecologic Society. Palm Springs, CA, October 19–21, 2006.     

The age distribution, rates, and types of surgery for stress urinary incontinence in the USA

The objective of this study was to describe the distribution of stress urinary incontinence (SUI) surgery across age groups in the USA in 2003. Patients were grouped into four age categories: reproductive, perimenopausal, postmenopausal, and elderly. Data from the 2003 National Hospital Discharge Survey and National Census were used to estimate surgical rates by age group. In 2003, 129,778 women underwent 165,776 surgical procedures for SUI. Of these women, 12.2, 53.0, 30.4, and 4.5% belonged to reproductive, perimenopausal, postmenopausal, and elderly age groups, respectively. Surgical rates (per 10,000 women) were 4, 17, 19, and 9 in these age groups, respectively. Complications occurred most frequently in reproductive age women. Overall, SUI surgical rates were similar for perimenopausal and postmenopausal women and exceeded that in the elderly population. The greatest percentage of surgical procedures occurred in perimenopausal women. Women at all stages of reproductive life may seek surgical treatment for SUI. This paper was presented at the annual meeting of the American Urogynecologic Society, Palm Springs, CA, October 19–21, 2006.