A Cheerio Tastes Like the Body of Christ: A Memoir

Schwab, Steven, M.A., Summer 2008 Integrated Arts and Education A Cheerio Tastes Like the Body of Christ: A Memoir Chair: Dr. James Kriley, Committee member: Dorothy Morrison Committee member: Karen Kaufmann This memoir documents my personal spiritual journey from childhood to present day. I have selected six events from my history that illustrate this theme. The memoir describes my family’s strong connection to the Roman Catholic religion, my participation in following the dogma of the Church, a rejection of the religion and the search for a philosophy that satisfied my needs. The settings for the pieces are in Idaho, Oregon, Italy, Sudan, Guatemala, and Montana

FDG-PET Lacks Sufficient Sensitivity to Detect Myxoid Liposarcoma Spinal Metastases Detected by MRI

Purpose. To document a case of myxoid liposarcoma in which PET scan was less sensitive than MRI in detecting spinal metastasis. Materials and Methods. The case of a 65-year-old female with a history of myxoid liposarcoma (MLS) of the thigh resected 5 years previously and now presenting with low back pain is presented. Her medical oncologist ordered an FDG-PET scan to evaluate distant recurrence. Subsequently, an MRI of her spine was obtained by her surgeon. Results. The FDG-PET scan was obtained 1 week prior to the MRI, and it did not show increased glucose uptake in the spine. Her MRI did show increased signal intensity in her lumbar spine. CT needle biopsy confirmed the lesion to be metastatic MLS. Conclusion. FDG-PET scans are utilized to detect distant recurrence of cancerous lesions. Myxoid liposarcoma has a unique propensity to metastasize to the spine. Previous reports have documented the unreliability of bone scintigraphy to diagnose these metastases. Our report demonstrates that FDG-PET may also lack the sensitivity needed to detect these lesions. We advocate total spine MRI when screening for metastases in this population when they present with back pain

The Acetabular Wall Index for Assessing Anteroposterior Femoral Head Coverage in Symptomatic Patients

Background: Understanding acetabular pathomorphology is necessary to correctly treat patients with hip complaints. Existing radiographic parameters classify acetabular coverage as deficient, normal, or excessive but fail to quantify contributions of anterior and posterior wall coverage. A simple, reproducible, and valid measurement of anterior and posterior wall coverage in patients with hip pain would be a clinically useful tool. Questions/Purposes: We (1) introduce the anterior wall index (AWI) and posterior wall index (PWI), (2) report the intra- and interobserver reliability of these measurements, and (3) validate these measurements against an established computer model. Methods: We retrospectively reviewed 87 hips (63 patients) with symptomatic hip disease. A validated computer model was used to determine total anterior and posterior acetabular coverage (TAC and TPC) on an AP pelvis radiograph. Two independent observers measured the AWI and PWI on each film, and the intraclass correlation coefficient (ICC) was calculated. Pearson correlation was used to determine the strength of linear dependence between our measurements and the computer model. Results: Intra- and interobserver ICCs were 0.94 and 0.99 for the AWI and 0.81 and 0.97 for the PWI. For validation against the computer model, Pearson r values were 0.837 (AWI versus TAC) and 0.895 (PWI versus TPC). Mean AWI and PWI were 0.28 and 0.81 for dysplastic hips, 0.41 and 0.91 for normal hips, 0.61 and 1.15 for hips with a deep acetabulum. Conclusions: Our data suggest these measures will be helpful in evaluating anterior and posterior coverage before and after surgery but need to be evaluated in asymptomatic individuals without hip abnormalities to establish normal ranges. Level of Evidence: Level III, diagnostic study. See Instructions for Authors for a complete description of levels of evidenc

Tissue microarray immunohistochemical detection of brachyury is not a prognostic indicator in chordoma.

Brachyury is a marker for notochord-derived tissues and neoplasms, such as chordoma. However, the prognostic relevance of brachyury expression in chordoma is still unknown. The improvement of tissue microarray technology has provided the opportunity to perform analyses of tumor tissues on a large scale in a uniform and consistent manner. This study was designed with the use of tissue microarray to determine the expression of brachyury. Brachyury expression in chordoma tissues from 78 chordoma patients was analyzed by immunohistochemical staining of tissue microarray. The clinicopathologic parameters, including gender, age, location of tumor and metastatic status were evaluated. Fifty-nine of 78 (75.64%) tumors showed nuclear staining for brachyury, and among them, 29 tumors (49.15%) showed 1+ (<30% positive cells) staining, 15 tumors (25.42%) had 2+ (31% to 60% positive cells) staining, and 15 tumors (25.42%) demonstrated 3+ (61% to 100% positive cells) staining. Brachyury nuclear staining was detected more frequently in sacral chordomas than in chordomas of the mobile spine. However, there was no significant relationship between brachyury expression and other clinical variables. By Kaplan-Meier analysis, brachyury expression failed to produce any significant relationship with the overall survival rate. In conclusion, brachyury expression is not a prognostic indicator in chordoma

Physical Function and Quality of Life After Resection of Mobile Spine Chondrosarcoma.

Study Design:Retrospective cohort study. Objectives:(1) To assess patient-reported outcomes-physical function, pain, and quality of life-in patients who underwent resection of a mobile spine chondrosarcoma. (2) To assess complications (90 days), readmissions, reoperations, oncological outcomes, and neurologic status. Methods:Thirty-three patients with spinal conventional chondrosarcoma resection between 1984 and 2014 at one hospital were included. The primary outcome measures were-minimally 6 months after surgery-the EuroQol 5 Dimensions (EQ5D), PROMIS-Physical Function, PROMIS-Pain Intensity, and Oswestry (ODI) Disability Index, or Neck (NDI) Disability established in 14 out of 20 alive (70.0%) patients. Complications, readmission, reoperations, oncological outcomes, and neurological status were reported for the complete cohort of 33 patients. Results:After spine chondrosarcoma resection, patients (n = 14) reported worse physical function (median 43, range 22-61, P = .026), worse quality of life (median EQ5D 0.70, range 0.04-1, P = .022), and comparable pain intensity (median 47, range 31-56, P = .362) when compared with US general population values. The median NDI/ODI was 25 (range 0-72) indicating mild to moderate disability. Patients undergoing reoperation had worse patient-reported outcomes than those who did not. Eighteen (55.5%) out of 33 patients suffered complications (90 days), 14 (42.4%) had unplanned readmission, and 13 (39.4%) underwent reoperation. Intralesional resection was associated with increased readmission, reoperation, and recurrence rate. Conclusions:Chondrosarcoma affects quality of life and physical function and its treatment frequently results in complications and reoperations. Our findings can be used to inform future patients about expected outcomes

Pelvic Morphology Differs in Rotation and Obliquity Between Developmental Dysplasia of the Hip and Retroversion

Background: Developmental dysplasia of the hip (DDH) and acetabular retroversion represent distinct acetabular pathomorphologies. Both are associated with alterations in pelvic morphology. In cases where direct radiographic assessment of the acetabulum is difficult or impossible or in mixed cases of DDH and retroversion, additional indirect pelvimetric parameters would help identify the major underlying structural abnormality. Questions/Purposes: We asked: How does DDH and retroversion differ with respect to rotation and coronal obliquity as measured by the pelvic width index, anterior inferior iliac spine (AIIS) sign, ilioischial angle, and obturator index? And what is the predictive value of each variable in detecting acetabular retroversion? Methods: We reviewed AP pelvis radiographs for 51 dysplastic and 51 retroverted hips. Dysplasia was diagnosed based on a lateral center-edge angle of less than 20° and an acetabular index of greater than 14°. Retroversion was diagnosed based on a lateral center-edge angle of greater than 25° and concomitant presence of the crossover/ischial spine/posterior wall signs. We calculated sensitivity, specificity, and area under the receiver operating characteristic (ROC) curve for each variable used to diagnose acetabular retroversion. Results: We found a lower pelvic width index, higher prevalence of the AIIS sign, higher ilioischial angle, and lower obturator index in acetabular retroversion. The entire innominate bone is internally rotated in DDH and externally rotated in retroversion. The areas under the ROC curve were 0.969 (pelvic width index), 0.776 (AIIS sign), 0.971 (ilioischial angle), and 0.925 (obturator index). Conclusions: Pelvic morphology is associated with acetabular pathomorphology. Our measurements, except the AIIS sign, are indirect indicators of acetabular retroversion. The data suggest they can be used when the acetabular rim is not clearly visible and retroversion is not obvious. Level of Evidence: Level III, diagnostic study. See Guidelines for Authors for a complete description of levels of evidenc

Intraosseous Synovial Sarcoma of the Proximal Tibia

Synovial Sarcoma is a malignant mesenchymal tumor that comprises 5–10% of all soft tissue sarcomas. The mean age of onset is thirty years old. Intraosseous presentation is very rare and has only been documented a few times. We report herein a case of a 53-year-old man with synovial sarcoma arising in the left proximal tibia. The patient underwent a wide surgical resection and reconstruction, followed by adjuvant chemotherapy. Three years later, the patient developed a local recurrence that resulted in an above-the-knee amputation. Eight months later, the patient has completed chemotherapy and is without signs of recurrence. The current recommended treatment for synovial sarcoma is wide surgical resection followed by chemotherapy as well as long-term followup. Despite improved surgical techniques, long-term survival rates remain low

Diet and Environment Shape Fecal Bacterial Microbiota Composition and Enteric Pathogen Load of Grizzly Bears

Background: Diet and environment impact the composition of mammalian intestinal microbiota; dietary or health disturbances trigger alterations in intestinal microbiota composition and render the host susceptible to enteric pathogens. To date no long term monitoring data exist on the fecal microbiota and pathogen load of carnivores either in natural environments or in captivity. This study investigates fecal microbiota composition and the presence of pathogenic Escherichia coli and toxigenic clostridia in wild and captive grizzly bears (Ursus arctos) and relates these to food resources consumed by bears. Methodology/Principal Findings: Feces were obtained from animals of two wild populations and from two captive animals during an active bear season. Wild animals consumed a diverse diet composed of plant material, animal prey and insects. Captive animals were fed a regular granulated diet with a supplement of fruits and vegetables. Bacterial populations were analyzed using quantitative PCR. Fecal microbiota composition fluctuated in wild and in captive animals. The abundance of Clostridium clusters I and XI, and of C. perfringens correlated to regular diet protein intake. Enteroaggregative E. coli were consistently present in all populations. The C. sordellii phospholipase C was identified in three samples of wild animals and for the first time in Ursids. Conclusion: This is the first longitudinal study monitoring the fecal microbiota of wild carnivores and comparing it to that o

BMC Nutrition: the voice of nutrition within the BMC series

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