Publications by authors named "Joshua Cornman-Homonoff"

29 Publications

  • Page 1 of 1

A Novel Treatment for Metastatic Serous Cystadenocarcinoma Using a Microwave Ablation: Case Report and Review of the Literature.

Pancreas 2021 Mar;50(3):434-440

From the Division of Surgical Oncology, Department of Surgery.

Abstract: The incidence of pancreatic cystic neoplasms has grown because of increased detection. Among these lesions, serous cystadenoma was traditionally thought to be universally benign and indolent. However, there is an exceedingly rare malignant variant of serous cystadenoma known as serous cystadenocarcinoma (SCAC) that can exhibit local invasion into adjacent structures, hepatic implants, and metastatic spread to the abdominal viscera. Diagnosis of SCAC can be challenging as it is histologically identical to serous cystadenoma. To better understand this entity, a review of all published accounts of SCAC was performed in which tumor and patient factors were characterized. In addition, we present the case of a 49-year-old woman who was found to have a solitary hepatic metastasis due to SCAC, 11 years after a distal pancreatectomy for serous cystadenoma. She was successfully treated with percutaneous microwave ablation and has no evidence of recurrence 3 years later. This report details the first published account of percutaneous ablation in such a setting. Compared with hepatectomy, hepatic ablation may offer a less invasive but equally effective treatment option in well-selected patients.
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http://dx.doi.org/10.1097/MPA.0000000000001785DOI Listing
March 2021

Combination uterine artery embolization and hysteroscopic resection for a symptomatic uterine leiomyoma: A collaborative single-session approach for better patient care.

Clin Imaging 2021 Jan 30;77:111-116. Epub 2021 Jan 30.

The Department of Radiology, Division of Interventional Radiology, NewYork-Presbyterian Hospital/Weill Cornell Medical Center, New York, NY, USA.

Uterine artery embolization (UAE) for symptomatic uterine fibroids is accompanied by transcervical fibroid expulsion in 3-15% of cases. It can be a source of significant patient distress, may require reintervention for removal, and is the most common reason for hospital readmission following UAE. Conversely, the success of hysteroscopic resection decreases with increasing fibroid size while the risk of complications increases. Because certain fibroid features identifiable on preoperative imaging predict need for eventual hysteroscopic resection, it is possible to prospectively identify such patients and employ an alternative management strategy. We present such an approach, illustrated in the case of a woman with a pedunculated broad-based uterine fibroid successfully managed via combination UAE and immediate hysteroscopic resection.
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http://dx.doi.org/10.1016/j.clinimag.2021.01.031DOI Listing
January 2021

Management of Refractory Ascites Due to Portal Hypertension: Current Status.

Radiology 2021 Mar 26;298(3):493-504. Epub 2021 Jan 26.

From the Department of Radiology and Biomedical Imaging, Section of Interventional Radiology, Yale School of Medicine, 330 Cedar St, TE-2, New Haven, CT 06520-8055 (D.C.M., J.C.); Department of Medicine, Division of Hepatology, New York-Presbyterian Hospital/Weill Cornell Medical Center, New York, NY (B.E.F.); Department of Radiology, Division of Interventional Radiology, University of Illinois at Chicago, Chicago, Ill (R.C.G., A.J.L., C.E.R.); and Department of Radiology, Interventional Radiology Service, Memorial Sloan-Kettering Cancer Center, New York, NY (H.Y.).

Refractory ascites is a costly and debilitating condition that occurs most frequently in the setting of substantial cirrhotic portal hypertension, where it portends a poor prognosis. Many treatment options are available, among them medical management, serial large volume paracenteses, transjugular intrahepatic portosystemic shunts, and implanted drainage devices. Although the availability of multiple therapies ensures that most patients will achieve satisfactory results, it can be challenging for the provider to select the appropriate treatment for each specific patient. This article reviews the available therapeutic options for refractory ascites and incorporates available data and clinical experience to suggest a linear stepwise management approach to enhance patient outcomes.
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http://dx.doi.org/10.1148/radiol.2021201960DOI Listing
March 2021

Mechanical thrombectomy for pulmonary embolism in patients with patent foramen Ovale.

CVIR Endovasc 2020 Nov 28;3(1):89. Epub 2020 Nov 28.

Section of Interventional Radiology, Department of Radiology and Biomedical Imaging, Yale University School of Medicine, 333 Cedar Street, New Haven, CT, 06520, USA.

Background: The current level of evidence for mechanical thrombectomy (MT) of pulmonary embolism (PE) in patients with patent foramen ovale (PFO) is limited.

Results: This was a retrospective analysis of 9 patients with PFO and acute high-risk or intermediate-high-risk PE, 6 with intermediate-high risk and 3 with high-risk PE. All underwent MT using the Inari FlowTriever System from Dec 2018 to November 2019. Six of these patients had confirmed deep venous thrombosis. The technical and clinical success rate for MT in all patients was 100% and 77.8%, respectively. Right-heart strain improved in 6/8 patients on follow-up echocardiography. Mean main pulmonary artery (MPA) pressure significantly decreased after MT (p < 0.012). One patient presented with altered mental status (somnolence and disorientation) prior to coronary artery angiogram and thrombectomy, developed a middle cerebral artery embolic stroke 1 day after MT, and recovered with minor sequalae and later was discharged. There was no in-hospital mortality.

Conclusions: MT using FlowTriever was feasible and safe, successfully improving MPA pressure in patients presenting with concurrent PFO and PE.
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http://dx.doi.org/10.1186/s42155-020-00180-9DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7695793PMC
November 2020

Commentary on: "Rebleeding and Mortality Risk Are Increased by ACLF but Reduced by Pre-emptive TIPS".

AJR Am J Roentgenol 2021 04 24;216(4):878. Epub 2021 Feb 24.

Department of Radiology and Biomedical Imaging, Section of Interventional Radiology, Yale School of Medicine, 330 Cedar St, TE-2, New Haven, CT 06520.

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http://dx.doi.org/10.2214/AJR.20.24811DOI Listing
April 2021

Preparing for liver surgery with "Alphabet Soup": PVE, ALPPS, TAE-PVE, LVD and RL.

Hepatobiliary Surg Nutr 2020 Apr;9(2):136-151

Department of Radiology and Biomedical Imaging, Section of Interventional Radiology, Yale School of Medicine, New Haven, CT, USA.

Future liver remnant (FLR) size and function is a critical limiting factor for treatment eligibility and postoperative prognosis when considering surgical hepatectomy. Pre-operative portal vein embolization (PVE) has been proven effective in modulating FLR and now widely accepted as a standard of care. However, PVE is not always effective due to potentially inadequate augmentation of the FLR as well as tumor progression while awaiting liver growth. These concerns have prompted exploration of alternative techniques: associating liver partition and portal vein ligation for staged hepatectomy (ALPPS), transarterial embolization-portal vein embolization (TAE-PVE), liver venous deprivation (LVD), and radiation lobectomy (RL). The article aims to review the principles and applications of PVE and these newer hepatic regenerative techniques.
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http://dx.doi.org/10.21037/hbsn.2019.09.10DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7188547PMC
April 2020

Incidental sonographic detection of bladder cancer in a woman with large uterine fibroids: significance and lessons learned.

Clin Imaging 2020 May 7;61:1-3. Epub 2020 Jan 7.

Division of Interventional Radiology, Department of Radiology, NewYork-Presbyterian Hospital/Weill Cornell Medical Center, New York, NY 10065, United States of America. Electronic address:

Uterine leiomyomas are the most common solid pelvic tumors in pre-menopausal women and typically present with abnormal uterine bleeding and/or symptoms of mass effect. A potential consequence of the space-occupying nature of these lesions is the decreased sensitivity for the detection of adjacent pelvic pathology, which can be particularly problematic given the overlap in symptoms between fibroids and other pelvic disease. We present the case of a woman with a large uterine fibroid who had multiple imaging evaluations before undergoing uterine fibroid embolization and on immediate follow-up sonography was discovered to have early-stage bladder cancer.
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http://dx.doi.org/10.1016/j.clinimag.2020.01.001DOI Listing
May 2020

Applications of transcatheter embolotherapy in preparation for liver transplantation and resection.

Chin Clin Oncol 2019 Dec 12;8(6):59. Epub 2019 Dec 12.

Department of Radiology and Biomedical Imaging, Section of Interventional Radiology, Yale School of Medicine, New Haven, CT, USA.

Although the liver-directed therapies offered by interventional radiology are often treated as alternatives to surgery, the roles they can play in preparation for surgical intervention are less often appreciated and thus underutilized. Locoregional therapies (LRT) can help establish and maintain candidacy for transplantation in patients with early-stage disease, and in those who are candidates for partial hepatectomy can improve post-resection outcomes. Appropriate patient selection is essential to realizing the maximal potential benefit, and herein we provide an overview of the options available and the indications for their use in the pre-operative period.
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http://dx.doi.org/10.21037/cco.2019.12.03DOI Listing
December 2019

Transhepatic portal stent placement and jejunal varix embolization for management of treatment-limiting gastrointestinal bleeding in a patient with unresectable recurrent intrahepatic cholangiocarcinoma.

Clin Imaging 2020 Feb 27;59(2):188-191. Epub 2019 Nov 27.

Department of Radiology, Division of Interventional Radiology, New York-Presbyterian Hospital/Weill Cornell Medical Center, NY, New York, United States of America. Electronic address:

Recurrent cholangiocarcinoma carries a dismal prognosis, with surgery providing the only potential cure. In those with unresectable disease, chemotherapy is the typical therapeutic mainstay but, given the myelosuppressive effects of this regimen, a pre-existing cytopenia may necessitate dose delay or reduction and contribute to poorer patient outcomes. We present a case of unresectable recurrent cholangiocarcinoma in which chronic gastrointestinal bleeding precluded chemotherapy administration, and which was successfully managed by portal vein stenting and ectopic variceal embolization.
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http://dx.doi.org/10.1016/j.clinimag.2019.09.012DOI Listing
February 2020

Association Between Diaphragmatic Paralysis and Ipsilateral Cervical Spondylosis on MRI.

Lung 2019 12 18;197(6):727-733. Epub 2019 Sep 18.

Division of Pulmonary and Critical Care Medicine, New York Presbyterian Hospital/Weill Cornell Medicine, 525 East 68th Street, New York, NY, 10065, USA.

Purpose: Diaphragmatic paralysis (DP) is an important cause of dyspnea with many underlying etiologies; however, frequently no cause is identified despite extensive investigation. We hypothesized that cervical spondylosis (CS), as manifest by cervical neuroforaminal stenosis on magnetic resonance imaging (MRI), is an underrecognized cause of unilateral DP.

Methods: A retrospective study was performed assessing cervical spine imaging utilization in the investigation of unilateral DP, and the contribution of CS to its pathogenesis. To assess the relationship between CS and DP, comparison was made between severity of ipsilateral and contralateral foraminal stenosis on cervical spine MRI in individuals with idiopathic DP, and to controls with DP of known etiology.

Results: Record searches identified 334 individuals with DP who were classified as idiopathic (n = 101) or DP of known etiology (n = 233). Of those with idiopathic DP, only 37% had undergone cervical spine imaging. Cervical spine MRIs, available for 32 individuals from the total cohort identified (n = 15 idiopathic DP, n = 17 DP of known etiology), were reviewed and severity of CS graded (0-2). In idiopathic DP, CS was significantly more severe (grade 2 stenosis) on the side of DP at C3-C4 (73% affected vs 13% unaffected side; p = 0.031) and C4-C5 (60% affected vs 20% unaffected side; p = 0.0039), while no difference was observed in DP of known etiology. Overall severity of CS across all cervical spine levels was significantly worse in idiopathic DP versus those with DP of known etiology.

Conclusions: In unilateral idiopathic DP, severity of CS is associated with DP laterality and is an underrecognized cause of diaphragmatic dysfunction. We propose that evaluation of 'idiopathic' DP should routinely include cervical spine imaging, preferably by MRI.
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http://dx.doi.org/10.1007/s00408-019-00271-yDOI Listing
December 2019

Intravascular Ultrasound-Guided Extraction of Free-Floating Inferior Vena Cava Tumor Thrombus Using the ClotTriever Mechanical Thrombectomy Device.

J Vasc Interv Radiol 2019 Oct 10;30(10):1679-1682.e1. Epub 2019 Aug 10.

Department of Radiology, Division of Interventional Radiology, New York Presbyterian Hospital Weill Cornell Medicine, 525 East 68th Street, New York, NY 10065.

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http://dx.doi.org/10.1016/j.jvir.2019.04.035DOI Listing
October 2019

Inferior Mesenteric Arterial Supply to a Symptomatic Uterine Myoma.

J Minim Invasive Gynecol 2020 02 9;27(2):248-249. Epub 2019 Jul 9.

Division of Interventional Radiology, Department of Radiology (Drs Cornman-Homonoff and Schiffman).

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http://dx.doi.org/10.1016/j.jmig.2019.07.003DOI Listing
February 2020

Percutaneous drainage of an infected endometrioma.

Clin Imaging 2019 Nov - Dec;58:105-107. Epub 2019 Jun 22.

The Department of Radiology, Division of Interventional Radiology, NewYork-Presbyterian Hospital/Weill Cornell Medical Center, New York, NY, USA.

Endometrioma superinfection is uncommon and poorly described in the literature. This rarity has precluded agreement on optimal management, with most authors treating these lesions as endometriomas rather than abscesses and thus recommending laparoscopic or open cystectomy or oophorectomy. We present a minimally-invasive alternative, illustrated in the case of an infected endometrioma which was successfully managed via image-guided percutaneous drainage.
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http://dx.doi.org/10.1016/j.clinimag.2019.06.012DOI Listing
March 2020

Management of Recurrent Sigmoid Volvulus via Nontransmural Percutaneous Colon Fixation.

J Vasc Interv Radiol 2019 Oct 17;30(10):1669-1671. Epub 2019 May 17.

Division of Interventional Radiology, New York-Presbyterian Hospital-Weill Cornell Medical Center, 525 East 68th Street, Box 141 New York, NY 10065.

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http://dx.doi.org/10.1016/j.jvir.2019.01.028DOI Listing
October 2019

Role of cone-beam CT augmented by navigational software in the single-session management of gastrointestinal hemorrhage and infected deep postoperative fluid collections.

Clin Imaging 2019 Sep - Oct;57:21-24. Epub 2019 Apr 23.

Department of Radiology, Division of Interventional Radiology, NewYork-Presbyterian Hospital/Weill Cornell Medical Center, New York, NY, United States of America. Electronic address:

Utilization of cone-beam CT with navigational software augmentation allows performance of both vascular and nonvascular interventions in a traditional fluoroscopy suite without need for additional hardware. The improvements in target identification and procedure time associated with use of these technologies suggest that they may be particularly beneficial in emergent settings where decreased procedure time correlates with improved outcomes. We illustrate these potential advantages through the successful single-session management of a clinically unstable patient with both gastrointestinal (GI) hemorrhage and infected postoperative fluid collections.
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http://dx.doi.org/10.1016/j.clinimag.2019.04.011DOI Listing
January 2020

Percutaneous Orthotopic IVC Construction in a Pediatric Patient with Symptomatic IVC Agenesis.

Cardiovasc Intervent Radiol 2019 Feb 12;42(2):308-312. Epub 2018 Nov 12.

Division of Interventional Radiology, NewYork-Presbyterian Hospital/Weill Cornell Medical Center, 525 East 68th Street, Box 141, New York, NY, 10065, USA.

Inferior vena cava agenesis is an uncommon condition usually attributed to embryologic dysgenesis. When symptomatic, unprovoked deep venous thrombosis and/or lower extremity venous congestion are the most frequent manifestations. Its rarity has precluded consensus regarding appropriate management. Symptomatic chronic venous congestion requires surgical construction of auxiliary venous pathways, which may involve substantial morbidity, prolonged recovery and extensive scarring. We report successful minimally invasive management via percutaneous endovascular orthotopic inferior vena cava construction in a pediatric patient, thereby obviating the need for surgery and its associated morbidity. LEVEL OF EVIDENCE: Level IV, case study.
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http://dx.doi.org/10.1007/s00270-018-2098-6DOI Listing
February 2019

Direct Percutaneous Access and Coil Embolization for Management of Recurrent Jejunal Variceal Hemorrhage in the Setting of a Pre-Existing TIPS.

J Vasc Interv Radiol 2018 11;29(11):1626-1629

Department of Radiology, Division of Interventional Radiology, New York Presbyterian Hospital/Weill Cornell Medical Center, 525 E. 68th St., P-518, New York, NY 10065.

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http://dx.doi.org/10.1016/j.jvir.2018.05.007DOI Listing
November 2018

Validation of Liver Imaging Reporting and Data System 2017 (LI-RADS) Criteria for Imaging Diagnosis of Hepatocellular Carcinoma.

J Magn Reson Imaging 2019 06 26;49(7):e205-e215. Epub 2018 Sep 26.

Department of Radiology, Columbia University Medical Center, New York, City, New York, USA.

Background: The Liver Imaging Reporting and Data System (LI-RADS) is being adapted by many clinical practices. To support continuation of its use, LI-RADS (LR) is in need of multicenter validation studies of recent LI-RADS iterations. Furthermore, while both gadoxetate and extracellular agents have been incorporated into LI-RADS, comparison of the diagnostic performance between the two has yet to be determined.

Purpose/hypothesis: To evaluate the rate, diagnostic performance, and interreader reliability (IRR) of LI-RADS 2017 for hepatocellular carcinoma, including LR major and ancillary features, with both gadoxetate and extracellular agent-enhanced MRI against a reference standard of histopathology or imaging follow-up.

Study Type: Retrospective.

Population: In all, 114 patients with 144 observations were included who met LR 2017 criteria for at risk and had at least one hepatic observation on liver MRI performed with either gadoxetate (n = 52) or an extracellular agent (n = 92) between 2010-2016, with histopathology (n = 103) or follow-up imaging (n = 41).

Field Strength/sequence: 1.5 and 3.0T/T -T WI, diffusion-weighted imaging.

Assessment: Three radiologists independently assessed major/ancillary features and assigned overall LI-RADS category for every observation.

Statistical Tests: Diagnostic performance of LR5/TIV+LR5 for identifying hepatocellular carcinoma (HCC) was compared between contrast agents with a generalized estimating equation. Weighted kappa was performed for interrater reliability.

Results: The frequency of HCCs among LR1, LR2, LR3, L4, LR5, LRTIV+LR5, and LRM observations were: 0% (all readers), 0-12.5%, 11.4-26.9%, 50-76%, 83.0-95.1%, 83.3-100.0%, and 45.0-65.0%, respectively. Sensitivity of LR5/LRTIV+LR5 for HCC was 59.7-71.4% and specificity 85.0-96.8%. LI-RADS specificity and positive predictive value for observations imaged with gadoxetate was higher than extracellular agent for the most inexperienced reader (R3) (P = 0.009-0.034). IRR for LI-RADS categorization was substantial (k = 0.661).

Data Conclusion: Increasing numerical LI-RADS 2017 categories demonstrate a greater percentage of HCCs. LR5/TIV+LR5 demonstrates excellent specificity and fair sensitivity for HCC. MRI with gadoxetate in liver transplant candidates may be beneficial for less experienced readers, although further large-scale prospective studies are needed.

Level Of Evidence: 4 Technical Efficacy: Stage 3 J. Magn. Reson. Imaging 2019;49:e205-e215.
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http://dx.doi.org/10.1002/jmri.26329DOI Listing
June 2019

Percutaneous Cryoablation for the Management of Chronic Pain Secondary to Locally Recurrent Rectal Cancer with Bowel and Nerve Root Involvement.

J Vasc Interv Radiol 2018 09;29(9):1296-1298

Department of Radiology, Division of Interventional Radiology, New York-Presbyterian Hospital/Weill Cornell Medical Center, 525 East 68th Street P-518, New York, NY 10065.

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http://dx.doi.org/10.1016/j.jvir.2018.02.022DOI Listing
September 2018

Celiac Plexus Block and Neurolysis in the Management of Chronic Upper Abdominal Pain.

Semin Intervent Radiol 2017 Dec 14;34(4):376-386. Epub 2017 Dec 14.

Department of Radiology, Division of Interventional Radiology, New York Presbyterian Hospital/Weill Cornell Medical Center, New York, New York.

Chronic upper abdominal pain occurs as a complication of various malignant and benign diseases including pancreatic cancer and chronic pancreatitis, and when present may contribute to lower quality of life and higher mortality. Though various pain management strategies are available as part of a multimodal approach, they are often incompletely effective and accompanied by side effects. Pain originating in upper abdominal viscera is transmitted through the celiac plexus, which is an autonomic plexus located in the retroperitoneum at the root of the celiac trunk. Direct intervention at the level of the plexus, referred to as celiac plexus block or neurolysis depending on the injectate, is a minimally invasive therapeutic strategy which has been demonstrated to decrease pain, improve function, and reduce opiate dependence. Various percutaneous techniques have been reported, but, with appropriate preprocedural planning, use of image guidance (usually computed tomography), and postprocedural care, the frequency and severity of complications is low and the success rate high regardless of approach. The main benefit of the intervention may be in reduced opiate dependence and opiate-associated side effects, which in turn improves quality of life. Celiac plexus block and neurolysis are safe and effective treatments for chronic upper abdominal pain and should be considered early in patients experiencing such symptoms.
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http://dx.doi.org/10.1055/s-0037-1608861DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5730442PMC
December 2017

Transarterial Embolization of a Bartholin Cyst before Resection.

J Minim Invasive Gynecol 2018 Sep - Oct;25(6):938-940. Epub 2017 Nov 28.

Department of Radiology, Division of Interventional Radiology, NewYork-Presbyterian Hospital/Weill Cornell Medical Center, New York, New York.

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http://dx.doi.org/10.1016/j.jmig.2017.11.016DOI Listing
November 2017

Preoperative Percutaneous Microwave Ablation of Long Bone Metastases Using a Parallel Medullary Approach for Reduction of Operative Blood Loss.

J Vasc Interv Radiol 2017 07;28(7):1069-1071

Department of Radiology, New York Presbyterian Hospital-Weill Cornell Medical Center, 525 E. 68th St., Box 141, New York, NY 10065.

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http://dx.doi.org/10.1016/j.jvir.2017.03.004DOI Listing
July 2017

Pre-operative renal artery embolization and suprarenal IVC filter placement for prevention of fat embolization in renal angiomyolipoma with venous extension.

Clin Imaging 2017 May - Jun;43:24-27. Epub 2017 Jan 26.

Division of Interventional Radiology, New York-Presbyterian Hospital, Weill Cornell Medical Center, 525 East 68th Street, Box 141, New York, NY 10065, USA. Electronic address:

Though generally considered benign, angiomyolipomas can invade through the renal vein into the inferior vena cava, putting patients at risk of catastrophic pulmonary fat embolization. Venous invasion is thus an indication for surgical resection but is thought to increase the risk of adverse operative outcomes including intraoperative hemorrhage and embolization of fat and/or tumor thrombus. We report a novel approach to mitigating these complications illustrated in the case of a 43-year-old woman with IVC-invasive renal AML who underwent successful radical nephrectomy after concurrent pre-operative renal artery embolization and placement of a retrievable suprarenal IVC filter.
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http://dx.doi.org/10.1016/j.clinimag.2017.01.012DOI Listing
November 2017

CT-guided epidural blood patch for treatment of CSF leak and pseudomeningocele following tethered cord release in a 3-year-old.

Clin Imaging 2016 Nov - Dec;40(6):1191-1194. Epub 2016 Aug 16.

Division of Neuroradiology, NewYork-Presbyterian Hospital, Weill Cornell Medical Center, 525 East 68th Street, Box 141, New York, NY 10065, USA. Electronic address:

An epidural blood patch (EBP) has become standard of care for management of postdural puncture headache, and in recent years, attempts have been made to expand its applicability. Its utility in the management of postsurgical pseudomeningocele remains poorly defined, and few reports describe its use in children. In this case, we report the successful management of lumbar pseudomeningocele via EBP in a 3-year-old after tethered cord release, thereby obviating the need for surgical repair and its potential morbidity.
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http://dx.doi.org/10.1016/j.clinimag.2016.08.010DOI Listing
January 2017

Quantified Facial Soft-tissue Strain in Animation Measured by Real-time Dynamic 3-Dimensional Imaging.

Plast Reconstr Surg Glob Open 2014 Sep 7;2(9):e211. Epub 2014 Oct 7.

Division of Plastic and Reconstructive Surgery, University of Pennsylvania, Philadelphia, Pa.

Background: The aim of this study is to evaluate and quantify dynamic soft-tissue strain in the human face using real-time 3-dimensional imaging technology.

Methods: Thirteen subjects (8 women, 5 men) between the ages of 18 and 70 were imaged using a dual-camera system and 3-dimensional optical analysis (ARAMIS, Trilion Quality Systems, Pa.). Each subject was imaged at rest and with the following facial expressions: (1) smile, (2) laughter, (3) surprise, (4) anger, (5) grimace, and (6) pursed lips. The facial strains defining stretch and compression were computed for each subject and compared.

Results: The areas of greatest strain were localized to the midface and lower face for all expressions. Subjects over the age of 40 had a statistically significant increase in stretch in the perioral region while lip pursing compared with subjects under the age of 40 (58.4% vs 33.8%, P = 0.015). When specific components of lip pursing were analyzed, there was a significantly greater degree of stretch in the nasolabial fold region in subjects over 40 compared with those under 40 (61.6% vs 32.9%, P = 0.007). Furthermore, we observed a greater degree of asymmetry of strain in the nasolabial fold region in the older age group (18.4% vs 5.4%, P = 0.03).

Conclusions: This pilot study illustrates that the face can be objectively and quantitatively evaluated using dynamic major strain analysis. The technology of 3-dimensional optical imaging can be used to advance our understanding of facial soft-tissue dynamics and the effects of animation on facial strain over time.
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http://dx.doi.org/10.1097/GOX.0000000000000185DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4229270PMC
September 2014

Evaluation of common genetic variants in 82 candidate genes as risk factors for neural tube defects.

BMC Med Genet 2012 Aug 2;13:62. Epub 2012 Aug 2.

Molecular Pathogenesis Section, Genome Technology Branch, National Human Genome Research Institute, National Institutes of Health, Bethesda, MD, USA.

Background: Neural tube defects (NTDs) are common birth defects (~1 in 1000 pregnancies in the US and Europe) that have complex origins, including environmental and genetic factors. A low level of maternal folate is one well-established risk factor, with maternal periconceptional folic acid supplementation reducing the occurrence of NTD pregnancies by 50-70%. Gene variants in the folate metabolic pathway (e.g., MTHFR rs1801133 (677 C > T) and MTHFD1 rs2236225 (R653Q)) have been found to increase NTD risk. We hypothesized that variants in additional folate/B12 pathway genes contribute to NTD risk.

Methods: A tagSNP approach was used to screen common variation in 82 candidate genes selected from the folate/B12 pathway and NTD mouse models. We initially genotyped polymorphisms in 320 Irish triads (NTD cases and their parents), including 301 cases and 341 Irish controls to perform case-control and family based association tests. Significantly associated polymorphisms were genotyped in a secondary set of 250 families that included 229 cases and 658 controls. The combined results for 1441 SNPs were used in a joint analysis to test for case and maternal effects.

Results: Nearly 70 SNPs in 30 genes were found to be associated with NTDs at the p < 0.01 level. The ten strongest association signals (p-value range: 0.0003-0.0023) were found in nine genes (MFTC, CDKN2A, ADA, PEMT, CUBN, GART, DNMT3A, MTHFD1 and T (Brachyury)) and included the known NTD risk factor MTHFD1 R653Q (rs2236225). The single strongest signal was observed in a new candidate, MFTC rs17803441 (OR = 1.61 [1.23-2.08], p = 0.0003 for the minor allele). Though nominally significant, these associations did not remain significant after correction for multiple hypothesis testing.

Conclusions: To our knowledge, with respect to sample size and scope of evaluation of candidate polymorphisms, this is the largest NTD genetic association study reported to date. The scale of the study and the stringency of correction are likely to have contributed to real associations failing to survive correction. We have produced a ranked list of variants with the strongest association signals. Variants in the highest rank of associations are likely to include true associations and should be high priority candidates for further study of NTD risk.
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http://dx.doi.org/10.1186/1471-2350-13-62DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3458983PMC
August 2012

Heavy prenatal alcohol exposure and risk of stillbirth and preterm delivery.

J Matern Fetal Neonatal Med 2012 Jun 5;25(6):860-3. Epub 2011 Jul 5.

Division of Epidemiology, Statistics and Prevention Research, Eunice Kennedy Shriver National Institute for Child Health and Human Development, National Institutes of Health, Department of Health and Human Services, Bethesda, MD 20892, USA.

We prospectively identified 96 women consuming at least 4 drinks/day during pregnancy by screening 9628 pregnant women. In these women with heavy prenatal alcohol use, there were three stillbirths and one preterm delivery; 98 matched nondrinking women had no stillbirths and two preterm births. Preterm rates did not differ significantly. The stillbirth rate was higher in the exposed group (p = 0.06). Additional investigation showed the stillbirth rate in the exposed population (3.1%) was significantly higher (p = 0.019) than the reported Chilean population rate (0.45%). Our data suggest that heavy alcohol consumption may increase the risk for stillbirth but not preterm delivery.
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http://dx.doi.org/10.3109/14767058.2011.587559DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4148070PMC
June 2012

Routine opt-out HIV testing strategies in a female jail setting: a prospective controlled trial.

PLoS One 2009 Nov 25;4(11):e7648. Epub 2009 Nov 25.

Yale University School of Medicine, Section of Infectious Diseases, AIDS Program, New Haven, Connecticut, United States of America.

Background: Ten million Americans enter jails annually. The objective was to evaluate new CDC guidelines for routine opt-out HIV testing and examine the optimal time to implement routine opt-out HIV testing among newly incarcerated jail detainees.

Methods: This prospective, controlled trial of routine opt-out HIV testing was conducted among 323 newly incarcerated female inmates in Connecticut's only women's jail. 323 sequential entrants to the women's jail over a five week period in August and September 2007 were assigned to be offered routine opt-out HIV testing at one of three points after incarceration: immediate (same day, n = 108), early (next day, n = 108), or delayed (7 days, n = 107). The primary outcome was the proportion of women in each group consenting to testing.

Results: Routine opt-out HIV testing was significantly highest (73%) among the early testing group compared to 55% for immediate and 50% for 7 days post-entry groups. Other factors significantly (p = 0.01) associated with being HIV tested were younger age and low likelihood of early release from jail based on bond value or type of charge for which women were arrested.

Conclusions: In this correctional facility, routine opt-out HIV testing in a jail setting was feasible, with highest rates of testing if performed the day after incarceration. Lower testing rates were seen with immediate testing, where there is a high prevalence of inability or unwillingness to test, and with delayed testing, where attrition from jail increases with each passing day.

Trial Registration: ClinicalTrials.gov NCT00624247.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0007648PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2777332PMC
November 2009

In vivo construction of recombinant molecules within the Caenorhabditis elegans germ line using short regions of terminal homology.

Nucleic Acids Res 2007 11;35(19):e133. Epub 2007 Oct 11.

Department of Biological Sciences, Dartmouth College, Hanover, NH 03755, USA.

Homologous recombination provides a means for the in vivo construction of recombinant DNA molecules that may be problematic to assemble in vitro. We have investigated the efficiency of recombination within the Caenorhabditis elegans germ line as a function of the length of homology between recombining molecules. Our findings indicate that recombination can occur between molecules that share only 10 bp of terminal homology, and that 25 bp is sufficient to mediate relatively high levels of recombination. Recombination occurs with lower efficiency when the location of the homologous segment is subterminal or internal. As in yeast, recombination can also be mediated by either single- or double-stranded bridging oligonucleotides. We find that ligation between cohesive ends is highly efficient and does not require that the ends be phosphorylated; furthermore, precise intermolecular ligation between injected molecules that have blunt ends can also occur within the germ line.
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http://dx.doi.org/10.1093/nar/gkm857DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2095804PMC
December 2007