Diagnosis of extra-pulmonary sarcoidosis can be difficult, and a biopsy is usually required We evaluated the utility of endobronchial ultrasound-transbronchial needle aspiration EBUS-TBNA in patients with suspected extra-pulmonary sarcoidosis with thoracic lymph nodes ≤10mm on chest computed tomography CT and no or minimal pulmonary infiltrates
 
  The Cleveland Clinic bronchoscopy registry was screened Patients with thoracic lymph nodes gt;10mm on short axis or significant pulmonary infiltrates in the chest CT scan were excluded Two separate analyses using expert consensus before and after release of bronchoscopy results were the reference standard
 
  15 patients met the inclusion criteria 40 had suspected ocular, 33 cardiac and 27 neurologic sarcoidosis Six patients 40 had EBUS-TBNA compatible with sarcoidosis When the reference standard was the consensus diagnosis blinded to bronchoscopy results, the sensitivity, specificity, positive predictive value and negative predictive value of EBUS-TBNA were 56, 83, 83, and 56 respectively The combination of a positive EBUS-TBNA and BAL CD4/CD8 improved the specificity from 83 to 100, but the difference was not statistically significant p=0074 When the reference standard was the consensus diagnosis with the bronchoscopic results, the sensitivity, specificity, positive predictive value and negative predictive value of EBUS-TBNA were 75, 100, 100, and 78 respectively
 
  In patients with suspected extra-pulmonary sarcoidosis, the EBUS-TBNA may be useful in the diagnosis of patients with thoracic lymph nodes ≤10mm and no or minimal pulmonary infiltrates on chest CT Larger and prospective studies are needed to validate our findings
 In patients with suspected extra-pulmonary sarcoidosis, the EBUS-TBNA may be useful in the diagnosis of patients with thoracic lymph nodes ≤10 mm and no or minimal pulmonary infiltrates on chest CT link Larger and prospective studies are needed to validate our findings
  To use sound touch elastography STE to assess the changes of renal cortex among different complications following renal transplantation
 
  A total of 31 patients with renal dysfunction after renal transplantation underwent an ultrasound-guided biopsy for pathological examination with conventional and STE ultrasound The maximum elastic modulus E
   was determined, and the biopsy specimen was evaluated for evidence of significant differences among four different complications drug-induced renal damage, acute rejection, chronic allograft nephropathy CAN, and BK virus BKV nephropathy link2 Receiver operator characteristics were used to compare the diagnostic efficacy of STE ultrasound according to the pathological results
 
  The quantitative index E
  of the STE technique was statistically significant among the four different complications plt;005 The distribution of the magnitude of E
  in the renal cortex was BKV nephropathy gt; CAN gt; acute rejection gt; drug induced renal damage The renal cortex E
  was statistically different for the severity of renal fibrosis and tubular atrophy plt;005
 
  Each of the four different complications of transplantation influenced the E
  of the renal cortex differently E
  can be used to assess the severity of renal fibrosis and tubular atrophy
 Each of the four different complications of transplantation influenced the Emax of the renal cortex differently Emax can be used to assess the severity of renal fibrosis and tubular atrophyMultiple noninvasive imaging modalities are available to measure biventricular function, although limited studies have assessed agreement between modalities in assessing left and right ventricular ejection fraction LVEF amp; RVEF in the same cohort of patients In this study we prospectively compared the agreement of 2-dimensional echocardiography 2DE, contrast enhanced 2DE, 3-dimensional echocardiography 3DE, and gated heart pool scan GHPS measures of LVEF and RVEF in patients with acute ST-elevation myocardial infarction We recruited 95 consecutive ST-elevation myocardial infarction patients mean age 614 ± 120, male 795 admitted to a major tertiary hospital between July 2016 and May 2018 Despite minimal inter- and intra-observer variability coefficient of variance 40 for patients whose LVEF was measured as ≤ 40 by 3DE or GHPS In conclusion, substantial variation exists between modalities when assessing LVEF and RVEF, although we demonstrate that 3DE and GHPS have the closest agreement This variability should be considered in clinical management of patients, and modalities should not be used interchangeably in sequential patient follow-upHeart failure HF is a leading cause of morbidity Strategies for preventing HF are paramount Prevalent extracoronary calcification is associated with HF risk but less is known about progression of mitral annular MAC and aortic valve calcification AVC and HF risk Progression of valvular calcification VC [interval change of gt;0 units/yr] was assessed by 2 cardiac computed tomography scans over a median of 24 years We used Cox regression to determine the risk of adjudicated HF and linear mixed effects models to determine 10-year change in left ventricular LV parameters measured by cardiac magnetic resonance imaging associated with VC progression We studied 5,591 MESA participants free of baseline cardiovascular disease Mean ± SD age was 62 ± 10 years; 53 women; 83 had no VC progression, 15 progressed at 1 site AVC or MAC and 3 at both sites There were 251 incident HF over 15 years After adjusting for cardiovascular risk factors, the hazard ratios 95 confidence interval of HF associated with VC progression at 1 and 2 sites were 162 121 to 217 and 188 114 to 309, respectively, compared with no progression p-for-trend less then 0001 Hazard ratios were higher for HFpEF 252 [163 to 390] and 249 [119 to 525] but nonsignificant for HFrEF Both AVC 161 [119 to 219] and MAC 150 [109 to 207] progression were associated with HF VC was associated with worsening of some LV parameters over 10 years In conclusion, VC progression was associated with increased risk of HF and change in LV function Interventions  https//wwwselleckchemcom/products/NVP-TAE684html  at reducing VC progression may also impact HF risk, particularly HFpEF
  Vulvar hematomas though common in obstetrical practice can rapidly evolve into a life-threatening condition if not managed appropriately Depending on clinical status and medical facility, conservative management, surgical debridement, or vessel-occlusion strategy can be considered
 
  Case 1 was a 28 year-old pregnant woman Increasing hematoma over 12cm in size was noted on postpartum Day 2 Debridement and arterial embolization were done Case 2 was a referred woman at age of 30 who delivered at a local obstetric clinic Debridement was performed successfully Case 3 was a 23 year-old woman with postpartum bilateral hematoma Drop in hemoglobin level prompted the medical team to transfer and airlift the patient for arterial embolization and subsequent vulva debridement
 
  Optimal management of hematoma is dependent on maternal hemodynamic condition, bleeding status, and availability of interventional radiology
 Optimal management of hematoma is dependent on maternal hemodynamic condition, bleeding status, and availability of interventional radiology
  We present fetal pleural effusions associated with Langerhans cell histiocytosis LCH
 
  We report a case of fetal pleural effusion in late pregnancy Due to developing rapidly over short period of time, the baby was delivered by caesarean section at 34 weeks gestation Generalised oedema, sparse haemorrhagic papules, pulmonary involvement, mediastinal mass and liver dysfunction were identified postnatally Structural malformations, maternal-fetal blood type incompatibility, chromosomal abnormalities and viral infection were excluded Mediastinal mass biopsy and immunohistochemical examinations confirmed the diagnosis of Langerhans cell histiocytosis LCH The baby is currently in a stable condition and undergoing regular chemotherapy
 
  Congenital LCH is a rare aetiology of fetal pleural effusions
 Congenital LCH is a rare aetiology of fetal pleural effusions
  Leiomyosarcoma and ovarian cancer are often diagnosed late due to the absence of initial symptoms Patients seek help when abdominal distension occurs; this is associated with pelvic tumor and carcinomatosis Initial imaging often reveals pelvic tumors with diffuse abdominal nodules; however, this imaging could be misleading, such as in the cases of splenosis
 
  A female presented with vaginal bleeding at our outpatient department Serum CA125 level was elevated Abdominal and pelvic CT showed multiple uterine masses and left adnexal cysts with peritoneal nodules Leiomyosarcoma or ovarian cancer with carcinomatosis was suspected Exploratory laparotomy was performed Multiple purple spots spreading over peritoneal cavity were noted during the surgery Pathological examination revealed adenomyosis with multiple uterine myomas and left ovarian endometrioma Splenic tissues peritoneal implants were observed
 
  In patients with a history of spleen rupture or splenectomy, splenosis should be considered in the differential diagnosis, especially in young patients
 In patients with a history of spleen rupture or splenectomy, splenosis should be considered in the differential diagnosis, especially in young patients
  We present prenatal diagnosis of a familial normal euchromatic variant of dup15q112q112 in a pregnancy with a favorable outcome
 
  A 32-year-old woman underwent elective amniocentesis at 17 weeks of gestation because of anxiety Amniocentesis revealed a karyotype of 46,XX,dup15q112q112 Simultaneous array comparative genomic hybridization aCGH analysis on the DNA extracted from uncultured amniocytes revealed the result of arr 1-22, X×2 with no genomic imbalance Cytogenetic analysis of the parental bloods showed that the mother had a karyotype of 46,XX,dup15q112q112, and the father had a karyotype of 46,XY Prenatal ultrasound findings were unremarkable A healthy 2948g female baby was delivered at 39 weeks of gestation without any phenotypic abnormality link3 Cytogenetic analysis of the cord blood revealed a karyotype of 46,XX,dup15q112q112
 
  Prenatal diagnosis of dup15q112q112 should include a differential diagnosis of a 15q112 BP1-BP2 microduplication encompassing TUBGCP5, CYFIP1, NIPA2 and NIPA1, and aCGH analysis is useful for the differential diagnosis under such a circumstance
 Prenatal diagnosis of dup15q112q112 should include a differential diagnosis of a 15q112 BP1-BP2 microduplication encompassing TUBGCP5, CYFIP1, NIPA2 and NIPA1, and aCGH analysis is useful for the differential diagnosis under such a circumstance
  We present prenatal diagnosis and molecular cytogenetic characterization of a de novo 319-Mb chromosome 14q3213-q322 deletion of paternal origin
 
  A 36-year-old woman underwent amniocentesis at 20 weeks of gestation because of an advanced maternal age Her husband was 36 years old Amniocentesis revealed a karyotype of 46,XY,del14q321q322 Simultaneous array comparative genomic hybridization aCGH analysis showed the result of a 14q3213-q322 deletion Prenatal ultrasound was unremarkable The parental karyotypes were normal and did not have such a deletion The pregnancy was subsequently terminated, and a malformed fetus was delivered with facial dysmorphism aCGH was applied on the DNA extracted from cord blood Polymorphic DNA marker analysis was applied on the DNAs extracted from placenta and parental bloods aCGH confirmed a 319-Mb 14q3213-q322 deletion or arr 14q3213q322 96,151,751-99,341,476×10 [GRCh37 hg19] encompassing 10 Online Mendelian Inheritance in Man OMIM genes of TCL1B, TCL1A, TUNAR, BDKRB2, BDKRB1, ATG2B, GSKIP, AK7, PAPOLA and VRK1