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"Hatmaker, Mark"
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Verification of Musculoskeletal FDG-PET-CT Findings Performed for Melanoma Staging
Background
The purpose of this study is to establish the validity of F-18-deoxyglucose positron emission tomography–computed tomography (FDG-PET-CT) scan staging for cutaneous melanoma when a musculoskeletal image abnormality is detected.
Methods
An institutional review board (IRB)-approved prospective database was queried to identify 342 melanoma patients treated between 4/1999 and 12/2007. A total of 682 whole-body FDG-PET-CT scans performed for staging were retrospectively reviewed to identify FDG-avid lesions in the deep soft tissues/muscle, bone or joints (i.e., musculoskeletal sites). Images were correlated with follow-up patient records.
Results
There were 187 true-positive sites on 94 scans and 26 false-positive sites on 22 scans. The overall false-positive rate was 13.9% (26/187). The positive predictive value (PPV) of an isolated musculoskeletal FDG-avid site was 31%. The PPV was highest (100%) when findings were present in both the bone and deep soft tissues. The relative risk of an isolated FDG-avid site compared with multiple FDG-avid sites not being melanoma was 5.33 [95% confidence interval (CI) 2.85–9.94]. The relative risk of an FDG-avid site seen in the appendicular region not being melanoma was 1.78 (95% CI 0.87–3.64) that of a site seen in the axial region.
Conclusions
FDG-PET-CT scanning for staging and surveillance in the extremities of patients with high-risk melanoma often creates confusing clinical scenarios. Our data suggest that a select subset of patients with isolated avid appendicular musculoskeletal scan may not have metastatic melanoma.
Journal Article
Boxing for MMA : building the fistic edge in competition & self-defense for men & women
This manual serves a dual purpose. First, it is a boxing primer to review (or discover) the boxing basics including stance, footwork, punches and combinations; and the filp side: defenses and counters for each fistic attack. Second, it takes these boxing skills and shoots them through an MMA prism that addresses the realities of mixed martial arts competition or combat. This guide will be your go-to resource for absorbing the boxing game and blending those skills into your MMA fighting arsenal.--Publisher.
Book
Boxer's bible of counterpunching : the killer response to any attack
Boxing is more about what you do in response to punches than punching prowess itself. This guide is an encyclopedia of counter boxing and includes every effective defense, response and follow-up combination to every attack.--Publisher.
Book