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Daub C.A.,Wake Forest Baptist Medical Center | Sepmeyer J.A.,Wake Forest Baptist Medical Center | Hathuc V.,Wake Forest Baptist Medical Center | Sakala M.D.,Wake Forest Baptist Medical Center | And 3 more authors.
American Journal of Roentgenology | Year: 2015

OBJECTIVE. Nonresectoscopic endometrial ablation techniques are being used as an alternative first-line management for menorrhagia. With these techniques, patients are at risk of developing delayed complications including painful obstructed menses, such as central hematometra and cornual hematometra, and postablation tubal sterilization syndrome. Pregnancy and the detection of endometrial cancer after ablation pose challenges in management. CONCLUSION. Radiologists should recognize the normal imaging findings in patients who have undergone endometrial ablation, be aware of the causes of treatment failure, and accurately identify delayed complications associated with these procedures.


Min W.,New York University | Gaines R.J.,Portsmouth Naval Medical Center | Sagi H.C.,Orthopaedic Trauma Service
Journal of Orthopaedic Trauma | Year: 2010

Entrapment of the bladder secondary to pelvic fracture is infrequently described in the literature. Entrapment has most commonly been found to occur through the actions of internal or external fixation. This case report presents bladder entrapment that was not detected until the patient developed genitourinary symptoms and dyspareunia 8 months after nonoperative treatment of a stable lateral compression pelvic fracture. Copyright © 2010 by Lippincott Williams & Wilkins.


Olderog C.K.,U.S. Army | Schmitz G.R.,Georgetown University | Bruner D.R.,Portsmouth Naval Medical Center | Pittoti R.,Wilford Hall Medical Center | And 2 more authors.
Journal of Emergency Medicine | Year: 2012

Background: Community-acquired methicillin-resistant Staphylococcus aureus (MRSA) is now the leading cause of superficial abscesses seen in the Emergency Department. Study Objectives: Our primary aim was to determine if an association exists between three predictor variables (abscess size, cellulitis size, and MRSA culture) and treatment failure within 7 days after incision and drainage in adults. Our secondary aim was to determine if an association exists between two clinical features (abscess size and size of surrounding cellulitis) and eventual MRSA diagnosis by culture. Methods: Logistic regression models were used to examine clinical variables as predictors of treatment failure within 7 days after incision and drainage and MRSA by wound culture. Results: Of 212 study participants, 190 patients were analyzed and 22 were lost to follow-up. Patients who grew MRSA, compared to those who did not, were more likely to fail treatment (31% to 10%, respectively; 95% confidence interval [CI] 8-31%). The failure rates for abscesses ≥ 5 cm and < 5 cm were 26% and 22%, respectively (95% CI -11-26%). The failure rates for cellulitis ≥ 5 cm and < 5 cm were 27% and 16%, respectively (95% CI -2-22%). Larger abscesses were no more likely to grow MRSA than smaller abscesses (55% vs. 53%, respectively; 95% CI -22-23%). The patients with larger-diameter cellulitis demonstrated a slightly higher rate of MRSA-positive culture results compared to patients with smaller-diameter cellulitis (61% vs. 46%, respectively; 95% CI -0.3-30%), but the difference was not statistically significant. Conclusion: Cellulitis and abscess size do not predict treatment failures within 7 days, nor do they predict which patients will have MRSA. MRSA-positive patients are more likely to fail treatment within 7 days of incision and drainage. Copyright © 2012 Elsevier Inc.


Gao J.,Northwestern University | Gauerke S.J.,Portsmouth Naval Medical Center | Martinez-Escala M.E.,Northwestern University | Guitart J.,Northwestern University | And 3 more authors.
Modern Pathology | Year: 2014

Subcutaneous panniculitis-like T-cell lymphoma is a rare subtype of cutaneous T-cell lymphoma. Virtually all cases are confined to the subcutaneous adipose tissue. In this report, we describe the first small series of subcutaneous panniculitis-like T-cell lymphoma (three patients) with bone marrow involvement. All patients presented with skin or soft tissue nodules, fever, and constitutional symptoms, and were diagnosed with subcutaneous panniculitis-like T-cell lymphoma based on the characteristic morphologic and immunophenotypic features of the subcutaneous lesions. Bone marrow core biopsies in these cases showed focal involvement by lymphoma with pathologic features similar to those seen in the diagnostic biopsies. Our observations suggest bone marrow involvement by subcutaneous panniculitis-like T-cell lymphoma does occur, and can be identified histologically and confirmed using standard immunohistochemistry. Our findings raise awareness of bone marrow involvement in this rare entity. However, the incidence and significance of bone marrow involvement in subcutaneous panniculitis-like T-cell lymphoma requires further evaluation. © 2014 USCAP, Inc. All rights reserved.


Allen B.C.,Medical Center Boulevard | Tirman P.,Medical Center Boulevard | Clingan M.J.,Medical Center Boulevard | Clingan M.J.,Portsmouth Naval Medical Center | And 3 more authors.
Abdominal Imaging | Year: 2014

Until recently, most solid renal neoplasms without macroscopic fat were presumed to represent renal cell carcinoma and were indiscriminately treated with nephrectomy. Expanding surgical options and ablative technologies, a growing acceptance of renal mass biopsy, the advent of targeted molecular agents, and advances in our understanding of tumor biology have challenged the wisdom of this approach and are ushering in a potential new era in which therapy is linked to histologic subtype and cytogenetics. This approach mandates evolution of our diagnostic algorithm beyond the distinction between solid and cystic and enhancing and nonenhancing. Computed tomography (CT) has traditionally been the imaging technique of choice for evaluating potential solid renal tumors, in large part due to its widespread availability, high spatial resolution, calcium discrimination, and multiphase, enhanced imaging capabilities. For the most part, however, CT is limited to characterization based upon the attenuation and enhancement characteristics of a lesion and necessitates exposure of patients to ionizing radiation. For these latter reasons, multiparametric magnetic resonance imaging (MRI) is being increasingly used to characterize solid renal masses. The purpose of this manuscript is to review our imaging approach to solid renal masses in adults utilizing MRI with an emphasis on a multiparametric approach augmented by clinical data. © Springer Science+Business Media 2014.

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