In Brief Background: Pelvic actinomycosis is difficult to diagnose and considered to be one of the rarer diseases confronting gynecologists. Some reports suggest a relationship between intrauterine contraceptive devices (IUDs) and colonization or infection of the genital tract with actinomycosis species. Case: A 48-year-old woman presented with pelvic discomfort, constipation, anorexia, and a 60-lb weight loss over 5 months. She had an IUD in place for 12 years but no pelvic examinations or Pap smears for 10 years. She had a large pelvic mass, a colonic stricture, and bilateral ureteral obstruction. The presentation, combined with the absence of fever and leukocytosis was that of an indolent, noninfectious process, which mimicked a pelvic malignancy. Laboratory values included creatinine 13.3 mg/dL, blood urea nitrogen 116 mg/dL, potassium 7.1 mmol/L, HCT 26%, CA-125 285 units/mL, carcinoembryonic antigen 10.1 ng/mL, hepatitis C antibody positive, and HIV screen nonreactive. She underwent cystoscopy, placement of ureteral stents, removal of a Copper 7 IUD, dilation and curettage of the uterus, Pap smear, proctosigmoidoscopy, exploratory laparotomy, total abdominal hysterectomy, bilateral salpingo-oophorectomy, lysis of adhesions, partial sigmoid resection, colostomy, Hartmann closure of the distal segment, peritoneal cytology, and appendectomy. Pathology revealed bilateral tuboovarian abscesses with sulfur granules, extensive ligneous cellulitis, acute and chronic inflammation of the appendix, adenomyosis, serosal inflammation of the uterus, and subserosal pericolonic abscesses. She was treated with hyperalimentation and antibiotics for 1 month with an uncomplicated recovery. Conclusion: The diagnosis of advanced actinomycotic pelvic inflammatory disease should be considered in the differential diagnosis in patients with a large pelvic mass and an IUD in situ or a recent history of IUD use. A pelvic mass, colonic stricture, and bilateral ureteral obstruction more often reflect the presence of malignancy, diverticular disease, or inflammatory bowel disease, but rarely can be an advanced pelvic actinomyces infection. The diagnosis of advanced actinomycotic pelvic inflammatory disease should be considered in the differential diagnosis in patients with a large pelvic mass and an IUD in situ or a recent history of IUD use. A pelvic mass, colonic stricture, and bilateral urethral obstriction more often reflect the presence of malignancy, biventricular disease, or inflammatory bowel disease, but rarely can be an advanced pelvic antinomies infection.
Abstract Non-Hodgkin lymphomas associated with acquired immunodeficiency syndrome are heterogeneous. Recently, a novel subtype of non-Hodgkin lymphoma occurring mostly in patients with acquired immunodeficiency syndrome has been described and designated as plasmablastic lymphoma. The histomorphologic and immunophenotypic findings of this distinct subtype of non-Hodgkin lymphoma have been characterized previously. Most patients present with oral cavity involvement. We report a case of plasmablastic lymphoma presenting as a lung tumor. To our knowledge, this is the first case report of this unusual subtype of diffuse large B-cell lymphoma in this location.
Abstract Background: Optical coherence tomography (OCT) is a high-resolution tissue-imaging modality that enables real-time imaging up to 2mm deep. The Perimeter B-Series OCT System combines wide field-OCT (WF-OCT) with an artificial intelligence system, ImgAssist, to assist clinicians in the detection of lesions suspicious for breast cancer. The objective of this investigational device trial is to assess adjunctive Perimeter B-Series OCT System use compared to standard care in identifying and addressing positive margins intraoperatively. Design: Prospective, multicenter, randomized, double-arm trial in females with biopsy-confirmed cancer undergoing breast conservation surgery (BCS) (NCT05113927). Following lumpectomy and standard-of-care intraoperative margin assessment participants will be randomized to a device or control arm (2:1 schema). Controls may undergo intraoperative pathology or frozen section analysis, per routine. WF-OCT will be done on all device arm specimens, with an opportunity to excise tissue from the lumpectomy cavity post-analysis. The new margin will be imaged with WF-OCT and the surgeon may take up to a maximum of 6 total shaves, including up to 2 shaves in each orientation. Eligibility: Adult females undergoing breast conservation surgery for biopsy-confirmed Stage 0-III invasive ductal and/or DCIS are eligible, including post-neoadjuvant therapy. Pregnant or lactating, those with Stage IV cancer, lobular carcinoma as primary diagnosis, previous ipsilateral breast surgery, multi-centric or bilateral disease, use of cryolocalization, or any treatment affecting margin integrity will be excluded. Specific Aim: The study hypothesis is that use of the Perimeter B-Series OCT System in BCS will reduce the proportion of subjects with at least 1 unaddressed positive margin. The primary endpoint is occurrence of aat least 1 unaddressed positive margin for a subject. The secondary endpoint is the number of unaddressed positive margins per subject. Safety includes Adverse Events; false-positive shaves per subject (device arm); and BREAST-Q Satisfaction with Breasts subscale. Other outcomes are total excised tissue volume, initial and all procedures including repeat surgeries; margin-level effectiveness (sensitivity, specificity, NPV and PPV); and operative time. Statistical Methods: The study was powered via the primary endpoint, assuming a 15% unaddressed margin rate, 90% power, 2:1 device-to-control ratio, and 10% loss of subjects due to screen or device failure. Both the primary and secondary effectiveness endpoints are based on within-subject comparison of the 2 treatments in the device arm (SOC+WF-OCT). Planned Accrual: 309 subjects (206 device, 103 control) will be enrolled at 8 centers over approximately 12 months. Citation Format: David Rempel, Andrew Berkeley, David Moos, Allison A. DiPasquale, Maryam Elmi, Richard E. Fine, Marie Lee, Bridget O’Brien, John F. Turner, Lee G. Wilke, Alastair Thompson. A prospective, multi-center, randomized, double-arm trial to determine the impact of the Perimeter B-Series OCT System on positive margin rates in breast conservation surgery [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2022; 2022 Apr 8-13. Philadelphia (PA): AACR; Cancer Res 2022;82(12_Suppl):Abstract nr CT230.
Abstract : The use of a neodymium: YAG laser to open opacified posterior capsules in the human eye was examined. This study involved the development of a one-dimensional hydrodynamic code to model the propagation of the shock wave in the vitreous, and the measurement of overpressures induced in a model system. The model system consisted of balanced salt solution in a cubical test cell. A pressure transducer was affixed to the rear of the cell, and 15 nsec Q-switched laser pulses were focused at distances of 6, 8, 10, and 14 mm from the transducer to initiate shock waves. Overpressures were measured for pulse energies of 3.75, 7.50, and 22.50 mJ at the focal point. Overpressures ranging from 0.018 - 0.432 atm were recorded at the transducer. The code was tested for a pulse energy of 3.75 mJ and predicted a pressure change of 2%, in excellent agreement with measured values. For pulse energies of 7.50 and 22.50 mJ, the maximum deviation was 5% from measured pressure differences.
Non-Hodgkin lymphomas associated with acquired immunodeficiency syndrome are heterogeneous. Recently, a novel subtype of non-Hodgkin lymphoma occurring mostly in patients with acquired immunodeficiency syndrome has been described and designated as plasmablastic lymphoma. The histomorphologic and immunophenotypic findings of this distinct subtype of non-Hodgkin lymphoma have been characterized previously. Most patients present with oral cavity involvement. We report a case of plasmablastic lymphoma presenting as a lung tumor. To our knowledge, this is the first case report of this unusual subtype of diffuse large B-cell lymphoma in this location.
