Update to the College of American Pathologists Reporting on Thyroid Carcinomas

Background The reporting of thyroid carcinomas follows the recommendations of the College of American Pathologists (CAP) protocols and includes papillary carcinoma, follicular carcinoma, anaplastic carcinoma and medullary carcinoma. Despite past and recent efforts, there are a number of controversial issues in the classification and diagnosis of thyroid carcinomas (TC) that, potentially impact on therapy and prognosis of patients with TC. Discussion The most updated version of the CAP thyroid cancer protocol incorporates recent changes in histologic classification as well as changes in the staging of thyroid cancers as per the updated American Joint Commission on Cancer staging manual. Among the more contentious issues in the pathology of thyroid carcinoma include the defining criteria for tumor invasiveness. While there are defined criteria for invasion, there is not universal agreement in what constitutes capsular invasion, angioinvasion and extrathyroidal invasion. Irrespective of the discrepant views on invasion, pathologists should report on the presence and extent (focal, widely) of capsular invasion, angioinvasion and extrathyroidal extension. These findings assist clinicians in their assessment of the recurrence risk and potential for metastatic disease. It is beyond the scope of this paper to detail the entire CAP protocol for thyroid carcinomas; rather, this paper addresses some of the more problematic issues confronting pathologists in their assessment and reporting of thyroid carcinomas. Conclusion The new CAP protocol for reporting of thyroid carcinomas is a step toward improving the clinical value of the histopathologic reporting of TC. Large meticulous clinico-pathologic and molecular studies with long term follow up are still needed in order to increase the impact of microscopic examination on the prognosis and management of TC

A new office-based procedure for treatment of snoring: The S.I.Le.N.C.E. study.

Objective: Demonstrate the safety and effectiveness of palatal foreshortening and stiffening in reducing snoring severity in nonobstructive sleep apnea (non-OSA) patients complaining of chronic disruptive snoring. Methods: In a US-based 8-center, open-label, prospective, single-arm cohort study, 52 consenting adults with chronic disruptive snoring (snoring impacting a patient\u27s life and causing patient or bed partner to seek medical intervention) were treated via office-based placement of resorbable, bidirectional, barbed suture implants into the soft palate under local anesthesia. Prior to intervention, home sleep tests (HSTs) were performed to rule out OSA and to document snoring noise level. Both subject and their bed/sleep partners (also consented) completed questionnaires including: bed/sleep partner\u27s scored visual analog scale (VAS) for subjects\u27 snoring severity, and subject scoring for Epworth Sleepiness Scale (ESS) and Pittsburgh Sleep Quality Index (PSQI). Following intervention, HSTs, VAS, ESS and PSQI were repeated at 30, 90 and 180 days. Results: Mean baseline bed/sleep partner VAS was 7.81 ± 1.59. Mean postimplant VAS scores decreased significantly at each measured interval; to 5.77±2.35 (P \u3c .001) at 30 days, 4.48 ± 1.81 (P \u3c .001) at 90 days, and 5.40 ± 2.28 (P \u3c .001) at 180 days. Post treatment improvements in daytime sleepiness and QOL were also observed. Two partial extrusions were reported. No further adverse events were identified. Conclusion: The current study demonstrates the safety and efficacy of the Elevoplasty procedure in reducing snoring severity over a follow-up period of 6 months. Level of Evidence: 2b

How Boulder Canyun Dam Ended Up in Black Canyon as Hoover Dam

Investigations of potential dam sites along the lower Colorado River in Boulder and Black Canyons were initially carried out by the Hydrology Branch of the U.S. Geological Survey in 1901-02. These were further evaluated by the newly-formed Reclamation Service from 1914 until the dam\u27s eventual construction in 1931-35. The seminal event triggering these studies was the accidental flooding of the Imperial Valley in 1905-07, which inundated more than 500 square miles of irrigable lands. It was assumed that a great embankment dam would be constructed near the head of Boulder Canyon, where the gorge was narrowest and comprised of granite. At this location the average depths of channel sands and gravels was about 65 feet. The site\u27s location thereafter caused the federal effort to be part of the Boulder Canyon Project. In 1919 California representatives in the House and Senate began introducing bills to approve what would eventually become the largest line item appropriation in American history, up to that time. In 1922-24 Reclamation received funds to explore alternative dam sites in Black Canyon, 18 to 23 miles downstream of the Boulder Canyon site. Dams of similar height built 20 miles downstream would increase the reservoir storage by about 40%, but the average depth to bedrock in the river channel was 120 feet. In 1924 Reclamation recommended a concrete gravity arch dam 740 ft high in Black Canyon. During each session of Congress in the 1920s the Boulder Canyon Act was introduced but failed to win congressional approval for nine years. Along the way, it became a more multi-faceted project, providing irrigation to an enlarged area, increased flood storage, constructing an All-American Canal along the international border, and the novel proposal for Reclamation to construct and operate the world\u27s largest hydroelectric facility, using the proceeds to repay to cost of the project. In 1927 a board of advisors were appointed to make detailed surveys of the Lower Colorado River and answer five questions that had been raised by critics of the act. These refinements and concessions eventually led to congressional approval in May 1928, but with a special proviso resulting from the recent failure of the St. Francis Dam built by the city of Los Angeles, which had killed ~430 people. Congress appointed a Colorado River Board (CRB) comprised of eminent engineers and geologists to make a detailed evaluation of Reclamation\u27s designs and report their findings within six months. The CRB\u27s recommendations were accepted and the Boulder Canyon Act was approved by Congress and President Calvin Coolidge in December 1928

Comparison of Pelvic Landmarks for Leg Length Discrepancy Measurement With Robotic Arm-Assisted Total Hip Arthroplasty

Background: Leg length discrepancy (LLD) is a common complication after total hip arthroplasty (THA) leading to significant morbidity and dissatisfaction for patients. A popular system for robotic arm-assisted THA utilizes preoperative computed tomography (CT) scans for surgical planning. Accurate measurement of leg length is crucial for restoring appropriate patient anatomy during the procedure. This study investigates the interobserver and interlandmark reliability of 3 different pelvic landmarks for measuring preoperative LLD. Methods: We compiled preoperative pelvic CT scans from 99 robotic arm-assisted THAs for osteoarthritis. Radiologic leg length measurement was performed using the robotic arm-assisted THA application by 2 orthopaedic residents using reference lines bisecting the following pelvic landmarks: the anterior superior iliac spines, acetabular teardrops, and most inferior aspect of the ischial rami. Results: On multivariate analysis, there was no significant difference found (P value = .924) for leg length measurement based on the 3 different pelvic anatomical landmarks. Leg length measurements showed interobserver reliability with significant Pearson correlation coefficients (r = 1.0, 0.94, 0.96, respectively) and nonsignificant differences in LLD means between subjects on paired sample (P value = .158, .085, 0.125, respectively) as well as between landmarks on pairwise comparison. Conclusions: The 3 pelvic landmarks used in this study can be used interchangeably with the lesser trochanter as the femoral reference point to evaluate preoperative LLD on pelvic CT in patients undergoing robotic-arm assisted THA. This study is the first of its kind to evaluate the interobserver and interlandmark reliability of anatomical landmarks on pelvic CT scans and suggests interchangeability of 3 pelvic landmarks for comparing leg length differences