Stephen P. Smith

Impact of [18F]‐2‐Fluorodeoxyglucose–Positron Emission Tomography/Computed Tomography on Previously Untreated Head and Neck Cancer Patients

Objectives: The role of fused modality [18F]‐2‐fluorodeoxyglucose–positron emission tomography/computed tomography (PET/CT) in diagnosing and accurately staging patients with primary, metastatic, and recurrent head and neck (HN) cancer is evolving, and the clinical implications need to be further defined. A few retrospective studies have been performed, but adequate sample sizes are lacking because the number of HN cancer patients is relatively small. This study evaluates the positive predictive value (PPV), sensitivity, specificity, and accuracy of PET/CT in previously untreated HN cancer patients at a single tertiary care institution. The purpose of this study is to evaluate the role of this new technology in the management of previously untreated HN cancer patients.

Computed tomography of primary transitional cell carcinoma of upper urinary tracts

Preoperative computed tomography (CT) was utilized to evaluate 20 patients with primary transitional cell carcinoma of the upper urinary tracts. Of the 20 patients, 18 (90%) had CT visualization of the tumor as either a discrete mass or local ureteral and/or renal pelvic wall thickening; 2 (10%) had false-negative examinations. Seven of the 20 patients (35%) had CT evidence of tumor extension demonstrated by frank tumor invasion beyond the urothelium or by perirenal pelvic and/or periureteral fat streaks. Of the 4 patients with fat streaks, 2 (50%) had superficial tumors (T(A)T2), 1 had a T1 (25%) tumor, and 1 had a T3 (25%) tumor. All 3 patients with CT findings of direct extension of tumor through the wall of the ureter or renal pelvis had T3 tumors. Among the 13 with localized noninvasive tumor on CT, 5 (38%) had superficial tumors (TA, TIS, T1), 5 (38%) had T2 tumors, and 3 (21%) had T3 tumors. Of the 5 patients with enlarged regional lymph nodes (greater than or equal to 1.5 cm) on CT, 2 had tumor confirmed histologically, 2 had subsequent negative CT-guided biopsies, and 1 had a negative lymphadenectomy. Distant metastasis was discovered in 1 patient. The data suggest that when CT demonstrates direct tumor extension through the renal pelvic or ureteral wall, it is a sensitive indicator of high-stage disease. However, in the absence of this finding, CT is of limited value in staging patients with primary transitional cell carcinoma of the pyeloureteral system.

The scientific basis for lipotransfer: is it the ideal filler?

A loss of volume results from a reduction in the subcutaneous fat, muscle atrophy, and changes in skeletal framework. Such loss of tissue volume compounded with tissue laxity leads to the aged appearance of the periorbital, perioral, cheek, and mandibular areas. Many facial plastic surgeons have sought to replace this volume with various injectable agents, both synthetic and autologous, in search for the ideal soft tissue filler. This article reviews the literature on lipotransfer and specifically the scientific basis underlying the approach.

Autologous Fat and Fillers in Periocular Rejuvenation

Facial volume loss is an important component of facial aging, especially in the periocular region. The authors evaluate the normal and aging anatomy of the periocular region and then discuss volume restoration of this region using hyaluronic acid, calcium hydroxylapatite, and autologous fat transfer. Preoperative assessment, operative technique, postoperative care, and complications are addressed.

Volume Rejuvenation of the Lower Third, Perioral, and Jawline

This is the third and final article discussing volumetric rejuvenation of the face. The previous two articles, Rejuvenation of the Upper Third and Management of the Middle Third, focused on the upper two-thirds of the face while this article focuses on the lower face, including the marionette area, jawline, and neck. Again, the authors of the previous two articles have provided a summary of rejuvenation utilizing a product of which they are considered an expert. Robert Glasgold has provided volumetric analysis of the region as an introduction.

Pegaspargase‐induced hypertriglyceridemia

A 52-year-old male is on a Phase III clinical trial of blinatumomab for newly diagnosed BCR-ABL-negative B-lineage acute lymphoblastic leukemia. He was randomized to Arm A and is being treated with cycle 2 regimen including cyclophosphamide, cytarabine, 6-mercaptopurine, pegaspargase, and methotrexate. He presented with diarrhea, right upper quadrant pain with rebound tenderness and guarding, and a positive Murphy’s sign. A serum chemistry panel showed alanine aminotransferase 196 U L (<52 U L), aspartate aminotransferase 252 U L (<40 U L), amylase 118 U L (<103 U L), and lipase 551 U L (<82 U L). A serum lipid panel showed triglycerides 3,060 mg dL (<150 mg dL), total cholesterol 518 mg dL (<200 mg dL), and HDL cholesterol 13 mg dL (>40 mg dL). (A baseline lipid panel before the start of treatment was not performed; however, baseline serum ALT, AST, and total bilirubin were within normal limits.) An abdominal ultrasound revealed an echogenic hepatic parenchyma likely representing hepatic steatosis and was otherwise negative for pancreatitis, gallstones, and focal hepatic lesions. Given the elevated triglyceride level and clinical suspicion for pancreatic dysfunction/acute pancreatitis, the patient underwent a single plasma volume exchange procedure replacing with 5% albumin without complication (Figure 1). His symptoms subsequently improved; a repeat lipid panel showed triglycerides 1,139 mg dL, total cholesterol 133 mg dL, and HDL cholesterol 3 mg dL. Leukemia cells depend on exogenous sources of L-asparagine for protein synthesis and survival. L-asparaginase is an FIGURE 1 Plasma from a patient with pegaspargase-induced hypertriglyceridemia who underwent therapeutic plasma exchange (A). The appearance is opaque, yellow-orange, and viscous secondary to marked hypertriglyceridemia. Compare to more normal-appearing plasma from a male patient with a normal lipid profile 11=2 months prior to the date of this photograph (B). The appearance is yellow, translucent, and straw-colored, and the indication for therapeutic plasma exchange in this patient is antiglomerular basement membrane disease

Technique for colon antirefluxing diversion in patient with ileal conduit

Abstract Colon conduits have increased in popularity because of the possibility of creating an antireflux ureterocolic anastomosis. Also the higher incidence of stomal problems associated with ileal conduits have led many to remove the ileal conduit and use a colonic segment instead. A case is presented of a patient who had a previous ileal conduit which was remodeled into an antirefluxing colon conduit.