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Introduction: Robot-assisted radical prostatectomy (RARP) with extended pelvic lymph node dissection (PLND) represents the gold standard surgical treatment for high-risk localized prostate cancer. PLND carries the risk of lymphocele formation, which can lead to complications such as deep vein thrombosis (DVT), infection, and voiding dysfunction. Many techniques have been described to minimize lymphocele formation, yet no method has seen widespread use or been described as sutureless. The objective of this study is to describe the novel, sutureless peritoneal window (PWIN) technique and assess its efficacy in lymphocele prophylaxis for extended PLND. Methods: This was a retrospective review of patients with high-risk prostate cancer undergoing RARP with extended PLND by a single surgeon from 2018 to 2024. PLND was carried out in the usual manner with bipolar cautery. PWIN technique is performed by excising a 3 × 5 cm PWIN over the lymphadenectomy bed to maintain lymphatic communication with the abdominal cavity. The primary outcome was a comparison between the incidence of symptomatic lymphoceles (SLs) with PWIN vs standard technique. SLs were defined as lymphoceles presenting with pain, DVT, voiding dysfunction, or infectious symptoms. Patients with asymptomatic lymphoceles were excluded. Results: Our study included 199 patients who underwent RARP with extended PLND. There were 46 patients (23.1%) in the standard approach group and 153 patients (76.9%) in the PWIN group. We identified 5/46 (10.9%) SLs in the standard technique, which were significantly higher than the 3/153 (2.0%) observed in the PWIN group (p = 0.017). There was no difference between the standard and PWIN cohorts regarding symptomology or treatment of their lymphocele. Conclusion: This study describes a novel, sutureless PWIN technique that significantly decreases SL after extended PLND. This technique offers a practical, time-efficient, and cost-effective alternative for lymphocele prevention. Future prospective studies are warranted to validate these findings.

Abstract Introduction: Abemaciclib is a cyclin-dependant kinase 4/6 inhibitor used to treat HR+/HER2- advanced or metastatic breast cancer with disease progression following endocrine or chemotherapy. In 2023, the FDA expanded its indication alongside endocrine therapy for early HR+/HER2- breast cancer with high risk of recurrence. We present a case of Abemaciclib induced pneumonitis to raise awareness of this rare complication in a relatively new treatment with growing use. Case Presentation: An 85 year old female with HFpEF, atrial fibrillation on Rivaroxaban and metastatic breast adenocarcinoma on Letrozole/Abemaciclib for three years, was admitted with non-productive cough, dyspnea and low-grade fever. On initial evaluation she was hypoxemic requiring 4L/min of oxygen, and in atrial fibrillation at 140bpm. Chest x-ray showed bilateral airspace and interstitial opacities with vascular congestion. Respiratory viral panel was negative, and labs showed lymphopenia, elevated BNP (5768pg/mL), elevated CRP (245mg/L) and ESR (135mm/h). Ceftriaxone and Azithromycin was started, and Letrozole/Abemaciclib held. After 72h, despite antibiotics, rate control and diuresis, her hypoxemia persisted. On reviewing prior PET-CT scans from her oncological monitoring, early mosaic attenuation in both lungs was noted. Chest CT was obtained and revealed diffuse ground-glass and reticular opacities with basilar apical gradient. Due to fragile respiratory status, bronchoscopy was deferred and induced-sputum obtained. Extensive testing was negative including autoimmune studies, serum beta-D-glucan and galactomannan, Histoplasma/Blastomyces, Pneumocystis jirovecii, AFB stain, sputum and blood cultures. With a negative workup and chest CT suggesting non-infectious pneumonitis, she was treated with Methylprednisolone for a Grade 4 Drug-Induced Interstitial Lung Disease (DIILD). Treatment resulted in rapid improvements, and she was eventually weaned off oxygen. She was discharged with prednisone taper and outpatient Pulmonology follow up with repeat CT in 6-8 weeks. Discussion: Abemaciclib is associated with severe, potentially fatal DIILD. In clinical trials MONARCH 1-3, 3.4% of patients had pneumonitis of any grade, 0.6% had Grade 3-4, and in 0.4% it was fatal. Many agencies including the FDA and MHRA (United Kingdom) released post-marketing surveillance warnings to raise awareness of this toxicity. Our case highlights an important differential when autoimmune or microbiological workup is negative, and the patient is not improving despite diuresis and antibiotics. PET-CT imaging is frequently done in these patients for oncological monitoring, and re-review of these prior scans during acute admissions can evaluate for early evidence of non-infectious pneumonitis. Prompt recognition, discontinuation of Abemaciclib and early steroid therapy can prevent progression to severe respiratory failure or death.

OBJECTIVE Despite the use of multiple glucose-lowering medications, glycemic targets are not met in a significant fraction of people with type 2 diabetes. In this prospective, observational study we assessed the prevalence of hypercortisolism, a potential contributing factor to inadequate glucose control. RESEARCH DESIGN AND METHODS Individuals with type 2 diabetes and HbA1c 7.5%–11.5% (58–102 mmol/mol) on two or more glucose-lowering medications with or without micro-/macrovascular complications or taking multiple blood pressure–lowering medications were screened with a 1-mg dexamethasone suppression test. Common causes of false-positive DSTs were excluded. The primary end point was the prevalence of hypercortisolism, defined as post-DST cortisol >1.8 μg/dL (50 nmol/L). Characteristics associated with hypercortisolism were assessed with multiple logistic regression. The percentage and characteristics of participants with hypercortisolism and adrenal imaging abnormalities were also assessed. RESULTS Post-DST cortisol was unsuppressed in 252 of 1,057 participants (prevalence 23.8%; 95% CI 21.3, 26.5). Hypercortisolism prevalence was 33.3% among participants with cardiac disorders and 36.6% among those taking three or more blood pressure–lowering medications. Adrenal imaging abnormalities were reported in 34.7% of participants with hypercortisolism. Use of sodium–glucose cotransporter 2 inhibitors (odds ratio 1.558), maximum-dose glucagon-like peptide 1 receptor agonists (1.544), tirzepatide (1.981), or a higher number of blood pressure–lowering medications (1.390); older age (1.316); BMI <30 kg/m2 (1.639); non-Latino/Hispanic ethnicity (3.718); and use of fibrates (2.676) or analgesics (1.457) were associated with higher prevalence (all P < 0.03). CONCLUSIONS Hypercortisolism was associated with hyperglycemia in approximately one-quarter of individuals with inadequately controlled type 2 diabetes despite multiple medications.

PURPOSE Chemotherapy-induced peripheral neuropathy is a potentially debilitating adverse effect of cancer therapy that can lead to delay, reduction, or discontinuation of cancer treatment. Population-based data on peripheral neuropathy incidence among young cancer survivors are lacking. METHODS Using a linkage between Medicaid, the California Cancer Registry, and hospitalization and emergency department data, we identified 6,028 adolescents and young adults (15-39 years) with Hodgkin lymphoma (HL), non-Hodgkin lymphoma (NHL), breast cancer, colorectal cancer, or testicular cancer and 418 children (<15 years) with HL or NHL during 2005-2017. We determined the cumulative incidence of peripheral neuropathy and its association with neurotoxic chemotherapy identified from Medicaid claims, using multivariable Cox proportional hazards regression models. RESULTS Of 6,446 patients, 1,007 were diagnosed with peripheral neuropathy. Across each cancer type, incidence was higher among patients receiving neurotoxic drugs. For example, compared with non-neurotoxic agents, 5-year cumulative incidence was higher with oxaliplatin for colorectal cancer (24.0% v 6.2%) and paclitaxel for breast cancer (22.6% v 5.1%). In multivariable analysis, the agents most strongly associated with peripheral neuropathy were brentuximab (±other neurotoxic drugs) for HL (hazard ratio [HR], 9.53 [95% CI, 5.95 to 15.26]); brentuximab (±vinca alkaloids; HR, 7.00 [95% CI, 4.13 to 11.87]) for NHL, paclitaxel for breast cancer (HR, 4.03 [95% CI, 3.05 to 5.31]); oxaliplatin for colorectal cancer (HR, 3.46 [95% CI, 2.23 to 5.36]); and cisplatin and etoposide for testicular cancer (HR, 2.06 [95% CI, 1.37 to 3.11]). CONCLUSION The high incidence of peripheral neuropathy highlights the need for frequent monitoring, new supportive care approaches, and development of novel therapeutic agents to minimize toxicity while maintaining treatment efficacy.

Although generative artificial intelligence can create podcast summaries of radiology articles, summaries are limited by hallucinations and lack of audience appropriateness, requiring further investigation to justify use as an educational tool.