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Simple Summary: This study investigates the safety and effectiveness of using image-guided biopsy to diagnose small renal masses less than 4 cm in size. Conducted retrospectively at a single center from 2015 to 2021, it focuses on patients without a previous cancer history or larger renal masses. By analyzing patient demographics, tumor size, biopsy methods, complications, and diagnoses, we aimed to determine the reliability of biopsy as a diagnostic tool. Our findings suggest that this method is safe and provides valuable diagnostic information, particularly for renal masses between 3 and 4 cm. The results have important implications for patient management, showing a significant number of benign diagnoses and influencing treatment choices, preventing unnecessary surgical intervention in a significant number of cases. This research contributes to the growing acceptance of renal mass biopsy in clinical practice, offering insights into its benefits for patient care. Introduction: Image-guided renal mass biopsy is gaining increased diagnostic acceptance, but there are limited data concerning the safety and diagnostic yield of biopsy for small renal masses (≤4 cm). This study evaluated the safety, diagnostic yield, and management after image-guided percutaneous biopsy for small renal masses. Methods: A retrospective IRB-approved study was conducted on patients who underwent renal mass biopsy for histopathologic diagnosis at a single center from 2015 to 2021. Patients with a prior history of malignancy or a renal mass >4 cm were excluded. Descriptive statistics were used to summarize patient demographics, tumor size, the imaging modality used for biopsy, procedure details, complications, pathological diagnosis, and post-biopsy management. A biopsy was considered successful when the specimen was sufficient for diagnosis without need for a repeat biopsy. Complications were graded according to the SIR classification of adverse events. A chi-squared test (significance level set at p ≤ 0.05) was used to compare the success rate of biopsies in different lesion size groups. Results: A total of 167 patients met the inclusion criteria. The median age was 65 years (range: 26–87) and 51% were male. The median renal mass size was 2.6 cm (range: one–four). Ultrasound was solely employed in 60% of procedures, CT in 33%, a combination of US/CT in 6%, and MRI in one case. With on-site cytopathology, the median number of specimens obtained per procedure was four (range: one–nine). The overall complication rate was 5%. Grade A complications were seen in 4% (n = 7), consisting of perinephric hematoma (n = 6) and retroperitoneal hematoma (n = 1). There was one grade B complication (0.5%; pain) and one grade D complication (0.5%; pyelonephritis). There was no patient mortality within 30 days post-biopsy. Biopsy was successful in 88% of cases. A sub-group analysis showed a success rate of 85% in tumors <3 cm and 93% in tumors ≥3 cm (p = 0.01). Pathological diagnoses included renal cell carcinoma (65%), oncocytoma (18%), clear cell papillary renal cell tumors (9%), angiomyolipoma (4%), xanthogranulomatous pyelonephritis (1%), lymphoma (1%), high-grade papillary urothelial carcinoma (1%), and metanephric adenoma (1%), revealing benign diagnosis in 30% of cases. The most common treatment was surgery (40%), followed by percutaneous cryoablation (22%). In total, 37% of patients were managed conservatively, and one patient received chemotherapy. Conclusion: This study demonstrates the safety and diagnostic efficacy of image-guided biopsy of small renal masses. The diagnostic yield was significantly higher for masses 3–4 cm in size compared to those <3 cm. The biopsy results showed a high percentage of benign diagnoses and informed treatment decisions in most patients. [ABSTRACT FROM AUTHOR]

Editorial for "Assessment of Prognostic Factors and Molecular Subtypes of Breast Cancer With a Continuous-Time Random-Walk MR Diffusion Model: Using Whole Tumor Histogram Analysis" Currently, assessments of response are conducted by ultrasound or magnetic resonance imaging (MRI) in clinical practice.[3] MRI is the most sensitive technique to determine the presence of a residual tumor due to its excellent soft tissue contrast. MRI texture features from tumor core and margin in the prediction of response to neoadjuvant chemotherapy in patients with locally advanced breast cancer. [Extracted from the article]

The future of general surgery of children as practiced in District General (DGHs) and Rural General Hospitals (RGHs) by adult general surgeons and urologists is uncertain. It is likely that this is because of a combination of the overall trend towards specialization, concerns about clinical risk; uncertainty within the profession about the behavior of the regulator and criminal justice system when considering cases of alleged incompetence; reduced and more targeted training time, curriculum changes, and perhaps a concern by other specialties regarding the ability of DGH and RGH surgeons to provide a safe service. The impact of this on regional pediatric surgical units (RPSUs) is however considerable. While transfer of some conditions such as infantile hypertrophic pyloric stenosis and intussusception is justifiable, transfer of others such as undescended testis and suspected torsion is not. Close communication between regional specialists and local generalists, preferably in the setting of a formal network, together with a change in the priorities of local medical and nonmedical managers and cooperation between competing Trusts is required. Strategies for dealing with the problem are available but require a change in management and National Health Service (NHS) ethos to enact effectively. Adherence to evidence-based best practice with the help of the "Getting It Right First Time (GIRFT)" initiative is vital and, together with targeted publicity and encouragement, the trend may not be irreversible. Level V. [ABSTRACT FROM AUTHOR]

Suggests that systematic provision for the participation of clients in decision making could mitigate a number of longstanding problems in child welfare. Argues that clients' opinions are not, a priori, any more or less subjective than those of child welfare professionals. (Author)

Introduction: In this era of rapidly expanding endovascular techniques, the use of hepatorenal bypass as treatment for a critically compromised renal perfusion has largely been forgotten. This article highlights the benefits of the technique both as a bailout strategy following complications from angioplasty and as a primary treatment in cases deemed unsuitable for endovascular intervention. Materials and Methods: Two patients are described whose renal viability was threatened by vascular compromise. One patient had a single functioning kidney with significant renal artery stenosis secondary to severe atherosclerotic disease and developed acute renal function deterioration following unsuccessful angioplasty. The second patient developed renal artery occlusion 3 years following open thoracoabdominal aortic aneurysm surgery. Both patients underwent successful hepatorenal bypass surgery and remain off dialysis 6 months after admission. Results: Both cases demonstrated the success of hepatorenal bypass with significant improvement in their renal function following open surgical repair. Conclusion: Hepatorenal bypass, although now seldom used because of available endovascular alternatives, remains an effective method of treating complicated cases of threatened kidney secondary to vascular insult. [ABSTRACT FROM AUTHOR]

Using a Maternal and Child Health clinic as an example, the social context of record production is stressed. The interorganizational context of the clinic, and its influence on the clinic's record production, illustrate Ginsberg's (TM 508 964) dysfunctional side effects on quantitative indicator production. (BW)

Breast cancer is the most common women's malignancy in the United States and is the second leading cause of cancer death. More than half of patients with breast cancer will develop hepatic metastases; this portends a poorer prognosis. In the appropriately selected patient, there does appear to be a role for curative (surgery, ablation) or palliative (intra- arterial treatments) locoregional therapy. Gynecologic malignancies are less common and metastases to the liver are most often seen in the setting of disseminated disease. The role of locoregional therapies in these patients is not well reported. The purpose of this article is to review the outcomes data of locoregional therapies in the treatment of hepatic metastases from breast and gynecologic malignancies. [ABSTRACT FROM AUTHOR]

Intra-arterial therapies have high antitumor activity for both primary and secondary hepatic malignancies. Selective infusions allow increased delivery of cytoreductive therapy to the tumor bed while sparing the normal hepatic parenchyma. These therapies are now often applied in the outpatient setting or with short overnight hospital stays and have a growing role in the treatment of liver-dominant disease from metastatic colorectal cancer and from neuroendocrine tumors. Less commonly, intra-arterial therapies are applied to treat secondary hepatic malignancies from breast cancer, melanoma, pancreatic adenocarcinoma, and soft-tissue sarcomas. The available data are limited and generally retrospective observational cohort series of single institutions. The purpose of this article is to summarize the recent literature on outcomes for intra-arterial therapy in nonsurgical patients. Multi-institutional registries and prospective data are greatly needed, as intra-arterial therapies are increasingly applied in these patients to stop progression of chemorefractory tumors. [ABSTRACT FROM AUTHOR]

Background: Fistula maturation is a complex multifactorial process with the effect of diabetes on vessel augmentation during fistula formation remaining unclear. Variation in results has reflected in a range of clinical practice with regard to patient selection and fistula formation and so requires more study. The aim of our study was to compare outcomes of diabetic and non-diabetic patients undergoing formation of a new upper limb arteriovenous fistula (AVF) to assess whether diabetes has a prognostic effect on outcome. Methods: A retrospective cohort study analysing 339 patients looking at both radiocephalic and brachiocephalic fistula formation in diabetic and non-diabetic patients was designed, with the primary outcome being fistula failure and then time taken to mature. Results: No difference was found between diabetic and nondiabetic patients in terms of fistula failure or time to mature. Conclusions: With AVF remaining the best access for dialysis, diabetic patients should not be discouraged from being offered AVF formation as they have equivalent outcomes to non-diabetic patients. Br J Diabetes 2016;16:119-122 [ABSTRACT FROM AUTHOR]

Aim: To test the hypothesis that MRI can monitor intraportal vein (IPV) transcatheter delivery of clinically applicable heparin-protamine-ferumoxytol (HPF) nanocomplex-labeled natural killer (NK) cells to liver tumor. Materials & methods: Liver tumor rat models underwent catheterization for IPV infusion of HPF-labeled NK cells (NK-92MI cell line). MRI measurements within tumor and adjacent liver tissues were compared pre- and post-NK cell infusion. Histology studies were used to identify NK cells in the target tumors. Results: For first time, we demonstrated that MRI tracks HPF-labeled NK cells migration within liver following IPV delivery. Conclusion: IPV transcatheter infusion permitted selective delivery of NK cells to liver tissues and MRI allowed tracking NK cell biodistributions within the tumors. [ABSTRACT FROM AUTHOR]

Creation of a VX2 tumor model has traditionally required a laparotomy and surgical implantation of tumor fragments. Open surgical procedures are invasive and require long procedure times and recovery that can result in post-operative morbidity and mortality. The purpose of this study is to report the results of a percutaneous ultrasound guided method for creation of a VX2 model in rabbit livers. A total of 27 New Zealand white rabbits underwent a percutaneous ultrasound guided approach, where a VX2 tumor fragment was implanted in the liver. Magnetic resonance imaging was used to assess for tumor growth and necropsy was performed to determine rates of tract seeding and metastatic disease. Ultrasound guided tumor implantation was successful in all 27 rabbits. One rabbit died 2 days following the implantation procedure. Two rabbits had no tumors seen on follow-up imaging. Therefore, tumor development was seen in 24/26 (92%) rabbits. During the follow-up period, tract seeding was seen in 8% of rabbits and 38% had extra-hepatic metastatic disease. Therefore, percutaneous ultrasound guided tumor implantation safely provides reliable tumor growth for establishing hepatic VX2 tumors in a rabbit model with decreased rates of tract seeding, compared to previously reported methods. [ABSTRACT FROM AUTHOR]

The article concerns with productive bureaucracies, corporations, and industry. Psychological considerations, represented first in the Human Relations School with the Hawthorne studies and later in organizational theory, became an integral part of this inquiry. The goal of such studies was knowledge which could be used to increase productivity. The relationship between psychology and bureaucratic problems encouraged new research in psychology in, for example, conflict resolution, group dynamics, and game theory. In recent years there has been criticism of the work produced in these areas of social psychology. The criticisms have partly to do with social psychology's preference for the collection of facts and the discussion of statistics over advances in theory, and partly to do with an epistemology which insists on the scientific nature of the enterprise, a notion which for some includes the conviction that the enterprise is value free and uncorrupted by any particular set of political beliefs.