Purpose: Prostate specific antigen levels can be normalized by the prostate volume to give a prostate specific antigen density (PSAd). Magnetic resonance imaging (MRI) can more accurately determine prostate zonal anat...Purpose: Prostate specific antigen levels can be normalized by the prostate volume to give a prostate specific antigen density (PSAd). Magnetic resonance imaging (MRI) can more accurately determine prostate zonal anatomy and prostate volumes compared to transrectal ultrasound, and hence may lead to more accurate PSAd measurements. Methods: Imaging and pathology of men undergoing prostate MRI from April 2007 to May 2009 were reviewed in this retrospective study. 73 patients were included for analysis, of which 45 had prostate cancer and 28 did not have cancer. Total, transitional zone, and peripheral zone values were determined by ultrasound prolate ellipse, MRI prolate ellipse, and MRI segmentation methods. Results: The study population showed an average PSA of 6.3 ng/mL, with the control mean PSA (8.8 ng/mL) being greater than the cancer group (5.3 ng/mL). Transrectal ultrasound underestimated the prostate volume (mean 27.7 mL versus MRI volume of 38.3 mL, p ≤ 0.001). No difference was seen between cancer and control populations using PSAd. PSAd correctly categorized low (Gleason < 7) and high-grade cancers (Gleason ≥ 7) in patients with malignancy. Conclusion: Transrectal ultrasound underestimates prostate volumes and hence is inaccurate in calculating PSAd. MRI more accurately depicts PSAd, however PSAd is unable to differentiate between patients with cancer and benign disease such as BPH or prostatitis.展开更多
A fistula formation between the esophagus and an aberrant right subclavian artery is a rare but fatal com-plication that has been mostly described in the setting of prolonged nasogastric intubation and foreign body er...A fistula formation between the esophagus and an aberrant right subclavian artery is a rare but fatal com-plication that has been mostly described in the setting of prolonged nasogastric intubation and foreign body erosion. We report a case of a young morbidly obese patient who underwent sleeve gastrectomy that was complicated by a postoperative leak at the level of the gastroesophageal junction. A covered esophageal stent was placed endoscopically to treat the leak. The pa-tient developed massive upper gastrointestinal bleeding secondary to the erosion of the stent into an aberrant retroesophageal right subclavian artery twelve days after stent placement. She was ultimately treated by endovascular stenting of the aberrant right subclavian artery followed by thoracotomy and esophageal repair over a T-tube. This case report highlights the multidis-ciplinary approach needed to diagnose and managesuch a devastating complication. It also emphasizes the need for imaging studies prior to stent deployment to delineate the vascular anatomy and rule out the possi-bility of such an anomaly in view of the growing popu-larity of esophageal stents, especially in the setting of a leak.展开更多
文摘Purpose: Prostate specific antigen levels can be normalized by the prostate volume to give a prostate specific antigen density (PSAd). Magnetic resonance imaging (MRI) can more accurately determine prostate zonal anatomy and prostate volumes compared to transrectal ultrasound, and hence may lead to more accurate PSAd measurements. Methods: Imaging and pathology of men undergoing prostate MRI from April 2007 to May 2009 were reviewed in this retrospective study. 73 patients were included for analysis, of which 45 had prostate cancer and 28 did not have cancer. Total, transitional zone, and peripheral zone values were determined by ultrasound prolate ellipse, MRI prolate ellipse, and MRI segmentation methods. Results: The study population showed an average PSA of 6.3 ng/mL, with the control mean PSA (8.8 ng/mL) being greater than the cancer group (5.3 ng/mL). Transrectal ultrasound underestimated the prostate volume (mean 27.7 mL versus MRI volume of 38.3 mL, p ≤ 0.001). No difference was seen between cancer and control populations using PSAd. PSAd correctly categorized low (Gleason < 7) and high-grade cancers (Gleason ≥ 7) in patients with malignancy. Conclusion: Transrectal ultrasound underestimates prostate volumes and hence is inaccurate in calculating PSAd. MRI more accurately depicts PSAd, however PSAd is unable to differentiate between patients with cancer and benign disease such as BPH or prostatitis.
文摘A fistula formation between the esophagus and an aberrant right subclavian artery is a rare but fatal com-plication that has been mostly described in the setting of prolonged nasogastric intubation and foreign body erosion. We report a case of a young morbidly obese patient who underwent sleeve gastrectomy that was complicated by a postoperative leak at the level of the gastroesophageal junction. A covered esophageal stent was placed endoscopically to treat the leak. The pa-tient developed massive upper gastrointestinal bleeding secondary to the erosion of the stent into an aberrant retroesophageal right subclavian artery twelve days after stent placement. She was ultimately treated by endovascular stenting of the aberrant right subclavian artery followed by thoracotomy and esophageal repair over a T-tube. This case report highlights the multidis-ciplinary approach needed to diagnose and managesuch a devastating complication. It also emphasizes the need for imaging studies prior to stent deployment to delineate the vascular anatomy and rule out the possi-bility of such an anomaly in view of the growing popu-larity of esophageal stents, especially in the setting of a leak.
