Ankermyers5776

Subsequent analysis of the patient's tumor revealed mutations in TP53 and MEN1. RNA sequencing was compared against the the Cancer Genome Atlas data set and clustered with the high steroid, proliferative subtype, associated with the worst prognosis. The tumor also demonstrated a low BUB1B/PINK1 ratio and G0S2 hypermethylation, both predictive of very aggressive ACC. This case represents a subset of ACC characterized by rapid and fatal progression. Clinically available predictors as well as recently reported molecular signatures and biomarkers correlated with this tumor's aggressiveness, suggesting that development and validation of combinations of biomarkers may be useful in guiding personalized approaches to patients with ACC. © Endocrine Society 2020.Background and Aims Certain situations preclude an endoscopic gastroenterostomy (EUS-GE) or enteral stent placement in gastric outlet obstruction (GOO), leaving patients with the option of a surgical bypass or enteral nutrition beyond the point of obstruction. We present a third option in these situations an endoscopic duodenojejunostomy (EUS-DJ) or jejunojejunostomy (EUS-JJ). Methods This was a retrospective review of 5 patients whose anatomy precluded an endoscopic gastrojejunostomy and an enteral stent, who underwent a successful EUS-DJ or EUS-JJ from 2016 to 2018. TCPOBOP Results Four EUS-DJs and 1 EUS-JJ were performed, with use of a 15-mm cautery-enhanced lumen-apposing metal stent by direct technique. All cases were technically successful. Three patients tolerated an unrestricted diet, but 2 patients needed enteral supplementation or total parenteral nutrition because of severe gastroparesis. There was 1 moderate adverse event bleeding from severe reflux esophagitis and gastroparesis. No reinterventions were needed on any of these stents, for a median follow-up time of 23 weeks. Conclusions When anatomy precludes an EUS-GE or enteral stent, an EUS-DJ or EUS-JJ may have similarly successful outcomes and could help avoid the need for enteral feeding tubes or surgery. © 2020 American Society for Gastrointestinal Endoscopy. Published by Elsevier Inc.Acute limb ischemia in young adults warrants thorough investigation to determine the underlying cause. Here, we present a case of acute upper limb ischemia in a marathon runner secondary to paradoxical embolism. The patient had associated deep venous thrombosis of the lower limb with multiple pulmonary emboli and patent foramen ovale. This case report emphasizes the under-recognition of intense endurance exercise as a risk factor for venous thromboembolism and highlights the potentially debilitating embolic sequelae of venous thromboembolism in patients with patent foramen ovale. © 2020 The Authors.This study presents the technique of percutaneous wire-target access of the superior vena cava (SVC) in patients with bilateral jugular-subclavian vein occlusion requiring a tunneled hemodialysis catheter. A 3-year retrospective review of five patients was performed. The femoral vein is accessed percutaneously and a 5F sheath inserted. This is followed by placement of a pigtail catheter (wire-target) in the SVC with cavography. The SVC is percutaneously cannulated at the level of the pigtail under fluoroscopy, and a guidewire is passed into the vena cava with confirmation by injection of contrast material. A tunneled hemodialysis catheter is then placed. The wire-target technique of SVC access can be used safely and effectively to establish upper body catheter access when traditional techniques are not possible. © 2020 The Author(s).Herein we report nine cases of carotid endarterectomy in which we used a cold atmospheric helium plasma device (J-Plasma; Apyx Medical Corporation, Clearwater, Fla). Although clinical reports are limited, experimental data indicate that this technology could be used for dissection and coagulation during surgery, yielding limited adjacent tissue damage. As a result, it could be extremely useful in procedures like carotid endarterectomy that necessitate careful dissection and coagulation with limited damage of adjacent neurovascular structures. © 2020 The Author(s).Median arcuate ligament syndrome is a rare and poorly understood condition that can have a significant impact on the quality of life of patients. Diagnosis is often difficult and delayed because of the need to exclude other pathologic processes. Treatment strategies traditionally involve open or laparoscopic division of the median arcuate ligament, with or without vascular reconstruction. This report portrays a case of median arcuate ligament syndrome with compression of two visceral arteries and distal embolic complications. A novel hybrid technique is described using intravascular ultrasound technology to aid in laparoscopic median arcuate ligament division. This allowed real-time intravascular visualization of the compressive segment, guided release of the ligament fibers, and demonstrated confirmation of decompression. © 2020 The Author(s).Retroperitoneal hematoma is a potential complication of femoral venous access that rarely leads to bilateral ureteral obstruction. We present the case of a 73-year-old woman who underwent an ablation procedure for atrial fibrillation complicated by laceration of an aberrant obturator artery during femoral venous cannulation, leading to a compressive retroperitoneal hematoma, bilateral ureteral obstruction, acute renal failure, and renal forniceal rupture. The patient was successfully treated with embolization of the inferior epigastric artery and aberrant obturator artery, hematoma evacuation, and ureteral stent placement. This case illustrates a rare complication of arterial laceration during femoral venous access without ultrasound guidance. © 2020 The Authors.Chimney/snorkel endovascular aneurysm repair (Ch-EVAR) enables the minimally invasive treatment of abdominal aortic aneurysm in anatomically challenging and high-risk surgical cases. Here, we present the case of a 77-year-old man with an abdominal aortic aneurysm associated with crossed fused renal ectopia and an ectopic renal artery arising directly from the aneurysm sac. After successful implementation of Ch-EVAR, computed tomography angiography at 18 months revealed no endoleaks, patency of the parallel graft, and normal renal vascularization and function. This report underscores the feasibility of Ch-EVAR in a case with high anatomic complexity. © 2020 The Authors.