Staff Publication

Mitral Valve-in-Ring Approach for High-Risk Pannus-Related Mitral Stenosis (2025)

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Type of publication:

Journal article

Author(s):

*Yera, Hassan O; Azam, Ziyad; *Azam, Najeeb M.

Citation:

Cureus. 17(10):e94204, 2025 Oct.

Abstract:

A male patient under follow-up for degenerative mitral regurgitation, treated with a Physio annuloplasty ring two decades earlier, developed progressive shortness of breath and fluid overload, corresponding to New York Heart Association (NYHA) class III/IV. A transoesophageal echocardiogram revealed significant mitral stenosis, with a mean gradient of 11.8 mmHg due to pannus formation around the annuloplasty ring. Surgical repair posed a mortality risk of 25%-35% because of the combined risks of redo surgery, reduced left ventricular systolic function and chronic kidney disease. A transcatheter mitral valve-in-ring (TMViR) procedure was the only feasible option. A 29 mm Sapien 3 valve (Edwards Lifesciences, Irvine, CA) was successfully implanted within the mitral ring. Four months following the procedure, the patient reported significant symptom relief and an improved quality of life (QOL), with a shift to NYHA class I/II. Follow-up echocardiography demonstrated a stable valve position, a mean gradient of 4 mmHg and mild mitral regurgitation. This case highlights TMViR as a viable option for high-risk patients with pannus-related mitral stenosis.

DOI: 10.7759/cureus.94204

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Missed on X-ray, Found on CT: A Retrospective Study on the Diagnostic Yield and Clinical Consequences of Occult Posterior Malleolus Fractures in Tibial Shaft Fractures (2025)

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Type of publication:

Journal article

Author(s):

Kanesan, Hariprasath; Choudhary, Zain; Singal, Sachin; *Kanesan, Mahesh; Hang-Kin Nam, Ronald; Radhamony, Niranj Ganeshan; Hamadto, Mohamed.

Citation:

Cureus. 17(10):e94260, 2025 Oct.

Abstract:

Background Posterior malleolus fractures (PMFs) are common in distal tibial shaft fractures yet are frequently occult on plain radiographs. Accurate preoperative characterization on CT may improve surgical planning and functional recovery. Methods We conducted a retrospective cohort study of consecutive adults (>=18 years) with mid- or distal tibial shaft fractures treated at a major trauma center (January 2022-December 2024). Demographics, imaging, fracture characteristics, management, and outcomes were abstracted. PMF detection was compared across radiography, CT, and intraoperative findings. Predictors of a posterior malleolus (PM) fragment being missed on radiography were evaluated with multivariable logistic regression. Among operatively treated cases, the effect of fixation strategy on postoperative full weight-bearing (FWB) was analyzed with a logistic model including fixation, PM status, and their interaction; pairwise, covariate-adjusted contrasts (emmeans with Tukey correction) compared strategies. An exploratory random forest provided permutation-importance rankings. Findings PMFs were present in 147/387 fractures (38.0%), more often in women (60.5%), closed injuries (76.9%), and distal fractures (98.0%). Radiography identified 116/147 PMFs (78.9%), and CT 120/147 (81.6%); 29/147 (19.7%) fragments were missed on radiographs but detected on CT or intraoperatively. Missed fragments were most frequent in undisplaced and intermediate-sized (33-50%) fragments; CT identified all posteromedial and >50% fragments. In adjusted analyses, fracture morphology was the principal correlate of radiographic omission: oblique patterns were less likely to be missed (adjusted odds ratio 0.18, 95% CI 0.04-0.60), whereas other demographic and injury variables were not significant. Among operatively managed fractures, intramedullary nailing was associated with the highest likelihood of achieving FWB and was statistically superior to plate and external fixation in pairwise, covariate-adjusted comparisons; the relative ranking of fixation methods did not differ by PM involvement. Neither PMF location (posteromedial, posterolateral, or undisplaced) nor fragment size independently predicted FWB, infection, or mal-/non-union. Conclusions Approximately two in five distal tibial shaft fractures harbour a PM fragment, and nearly one in five PMFs are occult on initial radiographs, particularly when undisplaced or of intermediate size. CT modestly increases detection and ensures complete characterisation of posteromedial and large fragments, supporting a low threshold for pre-operative CT in distal tibial fractures.

DOI: 10.7759/cureus.94260

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A Diagnostic Challenge: Sclerosed Hepatic Haemangioma Mimicking Malignancy (2025)

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Type of publication:

Journal article

Author(s):

*Lakhani, Umar A.

Citation:

Cureus. 17(10):e94449, 2025 Oct.

Abstract:

A 75-year-old lady presented to Accident and Emergency (A&E) with acute worsening shortness of breath and new palpitations. On assessment, she was found to have fast atrial fibrillation, signs of heart failure, and bilateral peripheral oedema. Investigations revealed pulmonary embolism and an incidental hepatic lesion on CT imaging, suspicious for malignancy. Multidisciplinary discussion led to liver biopsy, which confirmed a benign sclerosed haemangioma. The patient was managed conservatively for cardiac and thromboembolic complications. This case highlights the difficulty in differentiating sclerosed haemangiomas from malignant liver lesions on imaging alone and underscores the importance of biopsy and multidisciplinary decision-making in elderly patients with comorbidities. Learning points include diagnostic vigilance, safe management of anticoagulation, and avoidance of unnecessary surgery.

DOI: 10.7759/cureus.94449

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Long-Term Outcomes of Coronary Artery Aneurysms in Children With Kawasaki Disease: A Systematic Review (2025)

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Type of publication:

Systematic Review

Author(s):

Shafy, Shoaib Syed Mohammed; Salavarria, Karla Andrea Calderon; Saleh, Sara; *Cuino, Ingrid; Nadeem, Sadaf; Perez, Rebeca Cristina Romero; Shetty, Arushi; Adhikari, Kedar; Khatter, Tanya; Arasada, Chinmayee; Moussa, Naji; Mbaekwe, Eziamaka; Horsaengchai, Panchanit; Ali, Ramsha.

Citation:

Cureus. 17(10):e94418, 2025 Oct.

Abstract:

Kawasaki disease (KD) is a systemic inflammation of the blood vessels seen in children. It is the leading cause of acquired heart disease. Coronary artery aneurysm (CAA) is the most concerning complication, associated with long-term morbidity and mortality. This systematic review examined long-term outcomes of CAAs in KD, with emphasis on regression, complications, and the role of medical and surgical interventions. A total of 21 studies involving 10,922 patients were reviewed. The incidence of CAAs ranged from 3%-27%, mostly affecting infants under 6 months. Small and moderate aneurysms regressed in the majority of cases (>80%), whereas giant aneurysms were less likely to regress. Complications included thrombosis, myocardial infarction, major adverse cardiac events, and cardiac death. Early treatment with intravenous immunoglobulin (IVIG) enhanced the likelihood of regression. Aneurysms in the left anterior descending artery were less likely to regress, suggesting an anatomical influence. Coronary artery bypass grafting was the most common surgical intervention. Early and aggressive management with IVIG, with escalation to steroids or biologics when required, remains the preferred approach. Surgical intervention is sought for giant or persistent aneurysms. These findings emphasize the importance of timely diagnosis, risk stratification, and the establishment of standardized guidelines to optimize long-term care and surveillance of patients with KD.

DOI: 10.7759/cureus.94418

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IUGA Opinion Paper on Obstructed Defecation: Management of Clinical and Proctographic Rectoceles (2025)

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Type of publication:

Journal article

Author(s):

*Rachaneni, Suneetha; Dietz, Hans Peter; Latthe, Pallavi; Sirany, Annie; Spivak, Anna; Dua, Anupreet.

Citation:

International Urogynecology Journal.  2025 Nov 11.

Abstract:

INTRODUCTION AND HYPOTHESIS: Obstructed defecation syndrome (ODS) is a defecatory abnormality with a sensation of incomplete evacuation, the need to strain at stool, the need for digitation in the vagina, the anus, or the perineum. Anterior rectocele and rectal intussusception are the frequent pathologies behind ODS. The review focuses on the assessment and treatment of obstructed defecation in women with rectocele, recto-enterocele and rectal intussusception in the remit of a urogynecologist.

METHODS: A working subcommittee from the International Urogynecology Association (IUGA) Research and Development (R&D) Committee was formed with colorectal surgeons from the American Society of Colon & Rectal Surgeons (ASCRS). An initial document was drafted based on a literature review. The review focused on the treatment options of women with presenting with obstructed defecation and posterior compartment prolapse either on clinical examination or on imaging. After evaluation by the
entire IUGA R&D Committee revisions were made. The quality of the evidence was graded and used to form consensus recommendations.

RESULTS: Ultrasound and dynamic MRI are helpful imaging modalities in triaging patients. A defecating proctogram to evaluate the size of rectal intussusception and enterocele is the standard investigation. Conservative therapies are effective first-line management options. The transvaginal native tissue rectocele repair is a safe and effective first-line surgical treatment in women with obstructed defecation.

CONCLUSIONS: When evaluating patients with obstructive defecation, it is important to address anatomy as well as function. In the absence of a clinically significant rectocele or enterocele during vaginal examination, in women with obstructed defecation, referral to a gastroenterologist or colorectal surgeon for further evaluation and management is recommended.

DOI: 10.1007/s00192-025-06288-7

CT guided percutaneous lung biopsy - self-audit (2025)

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Type of publication:

Audit

Author(s):

*Abayaratne, Chulangani

Citation:

Shrewsbury and Telford Hospital NHS Trust, 2025

Abstract:

CT-guided percutaneous lung biopsy is a widely practiced interventional radiology procedure for
obtaining tissue samples from pulmonary lesions. Regular self-audit of such procedures is good
clinical practice and is recommended to ensure high diagnostic adequacy and low complication
rates, in line with national benchmarks.

In the UK, the British Thoracic Society (BTS) and the Royal College of Radiologists (RCR)
recommend regular audits to evaluate local diagnostic yield and complication rates and compare
them with national standards.

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A survey of the current state of training in inflammatory disease (IBD) surgery in the United Kingdom (UK) (2025)

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Type of publication:

Conference abstract

Author(s):

Argyriou O.; *El-Sayed C.; Drami I.; Celentano V.; Reza L.

Citation:

Colorectal Disease. Conference: 20th Scientific and Annual Conference of the European Society of Coloproctology, ESCP 2025. Paris France. 27(Supplement 1) (no pagination), 2025. Date of Publication: 01 Aug 2025.

Abstract:

Aim: Inflammatory Bowel Disease (IBD) surgery demands advanced technical skills due to the complexity and variability of procedures. High-quality training is essential, not only for the management of acute IBD-related emergencies but also for the development of a specialist IBD practice. This survey, developed by the Dukes' Club for UK colorectal surgery trainees and the IBD Subcommittee of the Association of Coloproctology of Great Britain and Ireland (ACPGBI), aims to evaluate the current state of IBD surgical training in the UK and to identify key areas and potential interventions for improvement. Method(s): An electronic survey was designed by members of the Dukes' Club executive committee and the ACPGBI IBD subcommittee, followed by dissemination via various professional networks, between September 2024 and April 2025.The survey investigated a number of key domains, including exposure to IBD procedures (routine/complex), participation in multidisciplinary team (MDT) meetings and joint surgical-gastroenterological clinics, career and fellowship intentions, as well as access to training resources. Result(s): The survey was completed by 103 participants (70% in training, 30% early years consultants).Senior trainees (ST6-ST8) represented 58.4% of the trainee participants.58.4% of trainees reported lack of exposure to IBD MDTs, with only 5.6% undertaking an active role in the MDT.Trainees reported minimal exposure to ileoanal pouch surgery and complex procedures such as strictureplasties and Kono-S anastomosis. In contrast, higher levels of exposure were noted for subtotal colectomies, ileo-caecal resections for Crohn's Disease, and IBD-related perianal fistula procedures. Conclusion(s): The survey demonstrated a lack of focus in IBD surgical training. Apart from high-quality educational activities that are delivered by the Dukes' Club and ACPGBI, a structured approach to ensure better exposure, through the training curriculum, is called for.

DOI: 10.1111/codi.70174

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Incidence and Survival Outcomes of Primary Parotid Follicular Lymphoma (PPFL): a Seer-Based Retrospective Analysis (2025)

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Type of publication:

Conference abstract

Author(s):

Backer G.; *Arunachalam J.

Citation:

HemaSphere. Conference: 30th Congress of theEuropean Hematology Association Annual Congress, EHA2025. Milan Italy. 9(Supplement 1) (pp 1214-1215), 2025. Date of Publication: 01 Jun 2025.

Abstract:

Background Primary malignant lymphomas of the parotid glands are rare, estimated to account for just 0.6% to 5% of all tumors of the parotid gland. Primary Parotid Follicular Lymphoma (PPFL) is a rare subtype of non-Hodgkin lymphoma (NHL) originating in the parotid gland, often associated with autoimmune disorders such as Sjogren's syndrome. Due to its low incidence, comprehensive population-based studies are scarce, limiting our understanding of epidemiological factors associated with PPFL and how they impact survival outcomes. Aims Using a large, population-based cancer registry, we aimed to evaluate the incidence trends and survival patterns of PPFL for the past 20 years in the US. Methods We conducted a retrospective population-based study utilizing data between 2000-2021 from the SEER (Surveillance, Epidemiology, and End Results) database. SEER is a program of the National Cancer Institute that collects epidemiological and survival data from cancer registries across the United States. We identified and extracted data from patients diagnosed with PPFL using ICD codes specific for primary tumors of the parotid gland (C07.9) and for follicular lymphoma (ICD codes 9690, 9691, 9695, 9698). Demographic data collected included year of diagnosis, age, sex, race, and area of residence. Incidence rates (IR) were calculated per 100,000 population and were age adjusted to the US standard population using SEER*stat 8.4.4. Using GraphPad Prism software, Kaplan-Meier survival analysis was done to calculate overall survival (OS) and cancer specific survival (CSS). Log rank (Mantel-Cox) test was used to compare survival outcomes between different groups. Results 793 patients with primary parotid follicular lymphoma were identified. 52% were male. 56% were older than 65 years at the time of diagnosis. 79% of patients were white, 10% were Hispanic, and 5% were black. 18% of patients had metastatic disease at initial presentation. IR was 0.050 (SE 0.002, 95% CI 0.045-0.055) for the years 2000-2010 and 0.036 (SE 0.002, 95% CI 0.032-0.040) from 2011 to 2021. Incidence was 29.7% higher in males compared to females with p = 0.0001(IR 0.048 vs 0.037, respectively). IR was 0.049 amongst white patients (SE 0.002, 95% CI 0.046 – 0.054), 0.021 amongst black patients (SE 0.003, 95% CI 0.015 – 0.029), and 0.031 amongst hispanic patients (SE 0.004, 95% CI 0.024-0.038). Patients between the ages of 75-79 years had the highest IR of 0.241 (SE 0.024, 95% CI 0.197- 0.293). Median overall survival (mOS) was 174 months. 5-year and 10-year CSS was 90% and 84%, respectively. mOS was 180 months in patients who received chemotherapy. mOS was 106 months in adults older than 65 years, compared to those younger (p<0.0001). White patients had the poorest mOS of 161 months (p=0.0042). There was no statistically significant difference in survival outcome based on gender. mOS was 109 months in patients residing in non metropolitan counties compared to mOS of 187 months in patients residing in metropolitan counties (p=0.0005). Summary/Conclusion PPFL primarily affects older adults, with high incidences in males and white patients. Though CSS rates are generally favorable, overall survival was found to be worse in white patients, adults aged > 65, and people residing in non metropolitan counties. These differences highlight potential disparities in disease outcomes and suggest the need for future research into factors influencing survival and access to care for patients with PPFL.

DOI: 10.1002/hem3.70152

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Exploring Disparities in Survival Outcomes of Primary Cardiac Diffuse Large B-Cell Lymphoma (DLBCL): a Seer Database Analysis (2025)

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Type of publication:

Conference abstract

Author(s):

Arvind S.; Shaikh G.; *Arunachalam J.; Naagendran M.S.; Meleveedu K.

Citation:

HemaSphere. Conference: 30th Congress of theEuropean Hematology Association Annual Congress, EHA2025. Milan Italy. 9(Supplement 1) (pp 3452-3453), 2025. Date of Publication: 01 Jun 2025.

Abstract:

Background Primary Cardiac Diffuse Large B-cell lymphoma (DLBCL) representing only 1.3% of cardiac tumors and 0.5% of extranodal lymphomas is an uncommon but aggressive malignancy that exclusively involves the heart or the pericardium. Favorable clinical outcomes depend on early detection and timely treatment with R-CHOP (rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisone) chemotherapy. Little research currently exists on the impact of healthcare access, socioeconomic and demographic factors on survival rates in primary cardiac DLBCL. Aims This study aims to provide an overview of survival outcomes of primary cardiac DLBCL and their association with demographic and clinical factors. Methods We collected data from SEER (Surveillance, Epidemiology, and End Results), which is a program of the National Cancer Institute (NCI) with statistical information on cancer incidence and survival in the United States. From the Research plus data (17 registries, 2000 – 2021), we extracted patients diagnosed with Diffuse large B-cell lymphoma (DLBCL) using the ICD code 9680/3 and having the primary cancer site as heart using code C38.0. Analysis was stratified based on age, sex, race, marital status, median household income and residency. Survival analysis was done with Graphpad Prism software, and survival outcomes were compared using the Log-rank test. Kaplan-Meier curves were used to visualize the data. Results 134 patients with cardiac DLBCL were identified. 64% of the patient population was 65 and older at diagnosis. 56% males and 44% females. 64% White, 14% Hispanic, 5% Black. 92% of patients lived in counties in metropolitan areas with a population ranging from 250,000 to 1 million. The marital status distribution at the time of diagnosis was as follows: 18% were single (never married), 16% were widowed, 4% were divorced, 2% were separated, 0.75% were in a domestic partnership and 54.5% were married. 72% of patients received chemotherapy, and 10% received external beam radiation therapy. Median overall survival (mOS) for primary cardiac DLBCL was 42 months. Cancer-specific survival (CSS) was 130 months. mOS was 144 months in patients under 65 years, and mOS was 26 months in patients aged 65 and older with p value=0.0010 (HR 2.402, 95% CI 1.470 to 3.926). In stage I disease, mOS was 144 months in < 65 and 33.5 months in 65+ (p = 0.0157). In stage IV, mOS was only 9 months in the 65+ age group, compared to those younger with p = 0.0254. mOS were 109 months in those who were married at the time of diagnosis, compared to a mOS of 25 months in those who were not (p value = 0.0030, HR 0.4825 95% CI 0.2867 to 0.8118). No statistically significant difference was found in overall survival when stratified based on sex, race, residency or median household income. Summary/Conclusion While the median cancer-specific survival of cardiac DLBCL was excellent (~ 10 years), the median overall survival was noted to be significantly lower (3.5 years), highlighting non-cancer causes of mortality. However, our analysis shows that advanced age (>65 yrs) has a significant negative impact on survival. While marital status seemed to be associated with better survival, reflecting the role of social support during cancer care, a firm conclusion requires understanding of additional factors. Future studies should explore the factors contributing to the non-cancer causes of mortality in cardiac DLBCL and poorer survival outcomes in the elderly to assist develop strategies to improve outcomes for this subset.

DOI: 10.1002/hem3.70152

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Epidemiological and Survival Trends of Alk-Positive Large B-Cell Lymphoma: a Seer (Surveillance, Epidemiology, and End Results) Study (2025)

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Type of publication:

Conference abstract

Author(s):

*Arunachalam J.; Meleveedu K.

Citation:

HemaSphere. Conference: 30th Congress of the European Hematology Association Annual Congress, EHA2025. Milan Italy. 9(Supplement 1) (pp 1319-1321), 2025. Date of Publication: 01 Jun 2025.

Abstract:

Background Anaplastic lymphoma kinase-positive (ALK+) large B-cell lymphoma (LBCL) is a rare subtype of diffuse large B-cell lymphoma (DLBCL), representing < 1% of all DLBCLs. Tumor growth is driven by ALK gene rearrangements which lead to proto-oncogene activation. Unlike ALK-positive anaplastic large-cell lymphoma (ALCL), ALK+ LBCL shows plasmablastic immunophenotype and often lacks typical T cell (CD2, CD3) and B-cell (CD20, CD79a) markers. It is known to be more aggressive than typical DLBCL due to limited response to conventional systemic chemotherapies like R-CHOP (rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisone), with a dismal 5-year OS of 8% in advanced stage disease. Off-label use of ALK inhibitors has demonstrated encouraging results in multiple case studies. Aims This study aims to analyze the incidence trends, and survival outcomes of ALK+ LBCL using the Surveillance, Epidemiology, and End Results database. SEER provides population-based data on cancer incidence, survival, and treatment outcomes by compiling various cancer registries across the U.S. Methods We conducted a retrospective population-based study between 2010-2021 utilizing the SEER database. Using ICD code 9737/3, we identified patients diagnosed with ALK+ LBCL. Demographic data, including age, sex, race, and stage, were collected. Incidence rates (IR) were calculated per 100,000 and age adjusted to the US standard population. Kaplan-Meier survival analysis was performed using GraphPad Prism to estimate overall survival (OS) and cancer specific survival (CSS). Log rank test was used to detect factors associated with survival outcomes. Results A total of 58 cases of ALK+ LBCL were included. IR was 0.0049 (SE 0.0010, 95% CI 0.0031-0.0073) during the years 2010-2015 and 0.0067 (SE 0.0011, 95% CI 0.0047-0.0094) from 2016-2021. IR was 0.0025 (SE 0.0007, 95% CI 0.0013-0.0044), 0.0035 (SE 0.0007, 95% CI 0.0022-0.0053), 0.0028 (SE 0.0008, 95% CI 0.0015-0.0049), and 0.0052 (SE 0.0015, 95%CI 0.0027-0.0091) in the age groups <20 years, 20-44 years, 45-64 years, and 65+ years respectively. Incidence rate ratio (IRR) was 4.08 (95% CI 2.08 – 7.98) when comparing males and females, indicating that incidence rate in males was 4 times higher than in females. 65% of patients presented with advanced stage disease at the time of diagnosis. Median time from diagnosis to treatment was 13 days. mOS median overall survival was 101 months. The 1-year and 10- year CSS rates were 86%, and 68% respectively. mOS was 53 months for those with advanced stage disease at initial presentation. mOS was 17 months for ages >65 years (p=0.0002), compared to those aged less than 65 years. In Ann Arbor stage I disease, mOS was 144 months in patients < 65 years and 33.5 months in 65+ age group (p = 0.0157). In Ann Arbor stage IV disease, mOS was only 9 months in 65+ age group with p value of 0.0254 when comparing with the younger age group. There was no statistically significant difference in survival outcomes based on sex, and race. Summary/Conclusion This is one of the largest retrospective studies on ALK+ LBCL. We found that incidence of anaplastic lymphoma kinase-positive large B-cell lymphoma is more common in males and adults older than 65. Survival outcomes continue to be poor, especially in older adults. Further multicenter research is warranted to explore the genomic framework and discover novel combination therapies, to improve patient outcomes.

DOI: 10.1002/hem3.70152

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