PurposeThe aims were to determine if the maximum standardized uptake value (SUVmax) of the primary tumor as determined by preoperative 18F-fluoro-2-deoxyglucose (18F-FDG) positron emission tomography (PET) is an independent predictor of overall survival and to assess its prognostic value after stratification according to pathological staging.MethodsA retrospective clinicopathologic review of 363 patients who had a preoperative 18F-FDG PET done before undergoing attempted curative resection for early-stage (I & II) non-small cell lung cancer (NSCLC) was performed. Patients who had received any adjuvant or neoadjuvant chemotherapy or radiation therapy were excluded. The primary outcome measure was duration of overall survival. Receiver-operating characteristic (ROC) curves were plotted to find out the optimal cutoff values of SUVmax yielding the maximal sensitivity plus specificity for predicting the overall survival. Survival curves stratified by median SUVmax and optimal cutoff SUVmax were estimated by the Kaplan-Meier method and statistical differences were assessed using the log-rank test. Multivariate proportional hazards (Cox) regression analyses were applied to test the SUVmax’s independency of other prognostic factors for the prediction of overall survival.ResultsThe median duration of follow-up was 981 days (2.7 years). The median SUVmax was 5.9 for all subjects, 4.5 for stage IA, 8.4 for stage IB, and 10.9 for stage IIB. The optimal cutoff SUVmax was 8.2 for all subjects. No optimal cutoff could be established for specific stages. In univariate analyses, each doubling of SUVmax [i.e., each log (base 2) unit increase in SUVmax] was associated with a 1.28-fold [95% confidence interval (CI): 1.03–1.59, p = 0.029] increase in hazard of death. Univariate analyses did not show any significant difference in survival by SUVmax when data were stratified according to pathological stage (p = 0.119, p = 0.818, and p = 0.882 for stages IA, IB, and IIB, respectively). Multivariate analyses demonstrated that SUVmax was not an independent predictor of overall survival (p > 0.05).ConclusionEach doubling of SUVmax as determined by preoperative PET is associated with a 1.28-fold increase in hazard of death in early-stage (I & II) NSCLC. Preoperative SUVmax is not an independent predictor of overall survival.

We present here a case of an uncommon complex uterine anomaly – Obstructed HemiVagina with Ipsilateral Renal Agenesis (OHVIRA), also known as Herlyn-Werner-Wunderlich syndrome in a 14-year-old girl along with sonographic (trans-abdominal and trans labial), and MRI findings. The patient underwent surgery wherein imaging findings were confirmed. An MRI has proved to be of great help in correct diagnosis avoiding surgical interventions/ laparoscopy, which were needed in past to diagnose this rare anomaly. We also discuss the development of this anomaly with the help of a relatively new theory of uro-genital development by Acien and review the literature.

Atherosclerosis is chronic disease, the prevalence of which has increased steadily as the population ages. Vascular injury is believed to be critical initiating event in pathogenesis of spontaneous atherosclerosis. Syndrome of accelerated atherosclerosis has been classically described in patients undergoing heart transplantation, coronary artery bypass graft, and percutaneous transluminal coronary angioplasty. In contrast to spontaneous atherosclerosis, denuding endothelial injury followed by thrombus formation and initial predominant smooth muscle cell proliferation is believed to be playing a significant role in accelerated atherosclerosis. There is no universal definition of rapid progression of atherosclerosis. However most studies describing the phenomenon have used the following definition: (i) > or = 10% diameter reduction of at least one preexisting stenosis > or = 50%, (ii) > or = 30% diameter reduction of a preexisting stenosis <50%, and (iii) progression of a lesion to total occlusion within few months. Recent studies have described the role of coronary vasospasm, human immunodeficiency virus, various inflammatory markers, and some genetic mutations as predictors of rapid progression of atherosclerosis. As research in the field of vascular biology continues, more factors are likely to be implicated in the pathogenesis of rapid progression of atherosclerosis.

The risk factor profile and the angiographic involvement differ considerably in the high-risk younger adults and substantiate the need for an aggressive approach directed toward primary and secondary preventions of premature cardiovascular disease.

A ortic dissection is a rare and potentially fatal sequela of percutaneous coronary intervention (PCI). The exact prevalence of aortic dissection after PCI is unknown, because occurrences might be unreported. The first case was reported in 1992. 1 We found 86 published instances 1-62 and have categorized these in detail. In addition, we present 2 new cases of aortic dissection consequent to PCI, and we discuss their specific treatment. Case Reports Patient 1A 52-year-old hypertensive man presented with acute inferior ST-segment-elevation MI (STEMI). He had a distant history of inferior myocardial infarction (MI) that had been treated with placement of a drug-eluting stent. At the current presentation, he was immediately taken for cardiac catheterization. Initial views of the left coronary system with use of a 6F Judkins left (JL)4 diagnostic catheter revealed no significant lesions. Views of the right coronary artery (RCA), examined with use of a 6F Judkins right (JR)4 diagnostic catheter, showed occlusion of the original proximal RCA stent. The diagnostic catheter was immediately removed, and a 6F JR4 guide catheter was used without difficulty to engage the RCA. A 180-cm Asahi Prowater Flex guidewire (Abbott Vascular, part of Abbott Laboratories; Abbott Park, Ill) was inserted into the RCA but could not cross the culprit lesion. This wire was exchanged for a 190-cm Hi-Torque Whisper guidewire (Abbott Vascular), and the lesion was successfully crossed with support from a 1.5 × 15-mm Maverick Over-the-Wire Balloon Catheter (Boston Scientific Corporation; Natick, Mass). Two brief inflations were done at pressures of 12 atm within the stent for 10 s each. The wire was upgraded to a 300-cm Asahi Prowater Flex wire while the Maverick balloon was still inside the artery. The patient reported chest pain, and his systolic blood pressure (SBP) fell to 78 mmHg. The balloon was removed. An angiogram showed dissection of the proximal RCA, extending retrograde into the right aortic cusp and ascending aorta (Fig. 1). In addition, slow flow and evidence of thrombus were noted in the RCA. A Pronto V3 extraction catheter (UDG Healthcare plc; Dublin, Ireland) was immediately inserted, and manual-aspiration thrombectomy was performed. Then, a 3.5 × 28-mm Vision ® bare-metal stent (Abbott Vascular), deployed in the proximal RCA at a pressure of 12 atm, was extended into the ostium to seal the dissection flap (Fig. 2).