A rare case of metastatic pancreatic adenocarcinoma presenting as a pulmonary embolism from nonbacterial thrombotic endocarditis

Nonbacterial thrombotic endocarditis (NBTE) also called, "Marantic endocarditis" occurs due to an underlying hypercoagulable state causing tissue damage and upregulation of the coagulation cascade, with noninfective vegetation formation on heart valves. Mitral and aortic valves are most commonly involved. NBTE is rare, with an incidence of 1.6%, with 65 cases identified during a 10-year autopsy analysis. The most common malignancies associated with NBTE include gynecological cancers, lung cancer, gastric cancer, and pancreatic cancers with adenocarcinoma histology being the greatest risk. Herein, we present a rare case of a 55-year-old male who presented with acute hypoxic respiratory failure secondary to pulmonary embolism due to nonbacterial thrombotic endocarditis. He was found to have advanced pancreatic adenocarcinoma on further investigation of the 2.2 cm hypodense cystic mass in the distal pancreatic body and tail, and complex liver masses which were incidentally found on computed tomography angiography (CTA) of the chest. This is a rare phenomenon and clinicians have to consider the hypercoagulable state associated with cancers, particularly pancreatic adenocarcinoma, and the risk of NBTE.     

Hypnotizability and the Treatment of Chronic Facial Pain

The Carleton University Responsiveness to Suggestion Scale (CURSS) of Spanos, Radtke, Hodgins, Bertrand ³ and Stam and Spanos, Radtke, Hodgins, Stam, and Bertrand (1983) was individually administered to a sample of 61 facial pain patients. The mean scores on the 3 CURSS suggestibility dimensions were higher than those of the college student norms. As in previous studies using the CURSS, however, objective scores were smaller when experienced involuntariness was taken into account. Observer scores of overt responses were highly related to self-scores of overt responses. The CURSS also proved a good predictor of reductions in clinical pain following a psychologically based treatment program.     

A MBULANCE,F IRE,AND P OLICE D ISPATCH T IMES C OMPARED WITH THE A TOMIC C LOCK

Objectives. To quantify any differences between the times used by public safety answering points (PSAPs) in a multijurisdictional county compared with the atomic clock and to determine whether there was consistency in any time differences. Methods. All 25 ambulance, fire, and police PSAPs were contacted by telephone. The current time in hours, minutes, and seconds on the dispatch center's timepiece was -requested. The atomic clock time was simultaneously recorded. Time differences between the reported and atomic clock times were calculated and the absolute values were used to calculate the mean difference. The procedure was repeated one week later. Consistency in time deviation was evaluated by subtracting the time differences between weeks 1 and 2 for each center. Results. All 25 centers were contacted and three declined to participate. Time differences ranged from ?551 to 117 seconds (mean difference: 61.2 ± 120.3) for week 1 and ?103 to 79 seconds (mean difference: 36.9 ± 33.4) for week 2. Time deviations between weeks 1 and 2 were: 0 seconds for one center, 1 to 30 seconds for 12 centers, 31 to 60 seconds for four centers, and more than 60 seconds for five centers. Conclusions. The maximum time difference between dispatch center and atomic clock times was 551 seconds. This difference may be clinically significant for time-dependent research, quality improvement tasks, or medical legal reviews when multiple PSAPs are involved. Lack of consistency in time deviation over one week suggests systematic adjustment for these differences may not be possible.     

Loading technique comparison in permanent I prostate implants

Treatment of prostate cancer utilizing iodine 125 (¹²⁵I) interstitial seed implants has become an accepted and widely used modality. Numerous variations in ¹²⁵I seed implant loading distribution techniques have developed as a result of the preferences of individual institutions implementing the modality. No particular universal standard is currently used for ¹²⁵I seed implants. A major concern with ¹²⁵I seed implants is coverage of the prostate with the desired dose and the minimization of dose to the urethra. A variation of seed distribution per individual anatomy is desirable. Historically, brachytherapy relied on dosimetry systems, such as the Paris, Quimby, and Manchester systems to achieve the desired dose distribution. Use of various peripherally loaded ¹²⁵I seed implant distributions to accommodate anatomic variations within the same institution prompted the interest of how the results compare to the Manchester system.     

Using contrast-enhanced helical CT to visualize arterial extravasation after blunt abdominal trauma: incidence and organ distribution.

OBJECTIVE: We evaluated the incidence and organ distribution of arterial extravasation identified using contrast-enhanced helical CT in patients who had sustained abdominal visceral injuries and pelvic fractures after blunt trauma. SUBJECTS AND METHODS: Five hundred sixty-five consecutive patients from four level I trauma centers who had CT scans showing abdominal visceral injuries or pelvic fractures were included in this series. The presence or absence of arterial extravasation, as well as the anatomic sites of arterial extravasation, was noted. We obtained clinical follow-up data, including surgical or angiographic findings. RESULTS: In our series, 104 (18.4%) of 565 patients had arterial extravasation. Of the 104 patients, 81 (77.9%) underwent surgery, embolization, or both. The combined rate of surgery or embolization in patients with arterial extravasation was statistically higher than expected at all four institutions (p <0.001). The spleen was the most common organ injured, occurring in 277 (49.0%) of 565 patients, and arterial extravasation occurred in 49 (17.7%) of 277 patients with splenic injury. Several other visceral injuries were associated with arterial extravasation, including hepatic, renal, adrenal, and mesenteric injuries. CONCLUSION: Based on the limited reports of arterial extravasation in the nonhelical CT literature, the percentage (18%) of clinically stable patients in our study with CT scans showing arterial extravasation was higher than anticipated. This finding likely reflects the improved diagnostic capability of helical CT. Although the spleen and liver were the organs most commonly associated with arterial extravasation, radiologists should be aware that arterial extravasation may be associated with several other visceral injuries.