Tumours and pseudotumours of the region of the ampulla of Vater: an endoscopic, clinical and pathological study.

From a large series of patients referred for endoscopic retrograde cholangiopancreatography to one endoscopist, 49 patients had the duodenoscopic appearance of a periampullary tumour. Thirty eight of these lesions were neoplastic, but the remaining 11 patients had inflammatory non-neoplastic lesions (pseudotumours). These could not be distinguished from the neoplasms on endoscopic appearances. The cholangiopancreatograms were similar except that the diameter of the pancreatic duct tended to be higher in the tumour group and gall stones were present significantly more often in the patients with pseudotumour. Endoscopic biopsy correctly diagnosed 28 of 34 ampullary carcinomas. Two of the 11 pseudotumour patients were subjected to surgical excision biopsy because of suspicious histological features of endoscopic biopsy. In the neoplastic group 19 patients underwent Whipple's procedure, seven surgical bypass, seven endoscopic sphincterotomy only and five died without successful biliary drainage. The overall one year survival was 44.7%. By contrast, the patients with pseudotumours were clinically well at a median follow up 24 months (range 12-41 months), after endoscopic sphincterotomy except for one 89 year old patient who died 22 months later from unrelated causes.     

The National Cancer Informatics Program (NCIP) Annotation and Image Markup (AIM) Foundation Model

Knowledge contained within in vivo imaging annotated by human experts or computer programs is typically stored as unstructured text and separated from other associated information. The National Cancer Informatics Program (NCIP) Annotation and Image Markup (AIM) Foundation information model is an evolution of the National Institute of Health’s (NIH) National Cancer Institute’s (NCI) Cancer Bioinformatics Grid (caBIG®) AIM model. The model applies to various image types created by various techniques and disciplines. It has evolved in response to the feedback and changing demands from the imaging community at NCI. The foundation model serves as a base for other imaging disciplines that want to extend the type of information the model collects. The model captures physical entities and their characteristics, imaging observation entities and their characteristics, markups (two- and three-dimensional), AIM statements, calculations, image source, inferences, annotation role, task context or workflow, audit trail, AIM creator details, equipment used to create AIM instances, subject demographics, and adjudication observations. An AIM instance can be stored as a Digital Imaging and Communications in Medicine (DICOM) structured reporting (SR) object or Extensible Markup Language (XML) document for further processing and analysis. An AIM instance consists of one or more annotations and associated markups of a single finding along with other ancillary information in the AIM model. An annotation describes information about the meaning of pixel data in an image. A markup is a graphical drawing placed on the image that depicts a region of interest. This paper describes fundamental AIM concepts and how to use and extend AIM for various imaging disciplines.     

Accessory muscles around the foot and ankle presenting as chronic undiagnosed pain. An illustrative case report and review of the literature

The differential diagnosis of ankle pain is extensive. Pathology may be classified as intra- or extra-articular. Additionally, ankle pain may be traumatic or non-traumatic. One of the unusual differential diagnoses for pain in the ankle is an accessory muscle. Magnetic resonance imaging is the radiological investigation of choice. However, this is invariably reported as normal unless one specifically looks for an accessory muscle. The purpose of this report is to highlight important features of these muscles and to draw attention to this uncommonly reported condition.     

Evaluating county-level spatial prevalence and clustering of medicare beneficiaries in Mississippi

Objective

This study seeks to examine how the extent of socioeconomic deprivation, racial and ethnic isolation, and health disadvantage differ among Medicare beneficiaries in Mississippi. Methods: Geographical information system (GIS) mappings are used in conjunction with cluster analysis to examine patterns of disparities in disease distribution, healthcare utilization and socioeconomic well-being among different counties in Mississippi.