ASHISH SINGH - Academia.edu (original) (raw)
Papers by ASHISH SINGH
Singapore Medical Journal, 2013
Mesothelioma is a slow-growing insidious lesion of neoplastic aetiology arising from the pleural,... more Mesothelioma is a slow-growing insidious lesion of neoplastic aetiology arising from the pleural, peritoneal or pericardial mesothelium. It shows a predilection for the surfaces of the pelvic viscera and has a high rate of recurrence after excision. Cystic mesotheliomas are not associated with asbestos exposure. We report a case of cystic mesothelioma of the peritoneum encasing the ovary, which presented as a cystic adnexal mass. As highlighted in this case and other recent reports, a cystic mesothelioma should not be referred to as a benign cystic mesothelioma, as it has potential for locoregional invasion, as well as distant nodal and serosal metastases. This tumour should be treated with aggressive cytoreductive surgery and appropriate chemotherapy. We review the differential diagnosis of this rare entity and suggest guidelines for its differentiation.
PloS one, 2015
The provision of affordable health care is generally considered a fundamental goal of a welfare s... more The provision of affordable health care is generally considered a fundamental goal of a welfare state. In addition to its role in maintaining and improving the health status of individuals and households, it impacts the economic prosperity of a society through its positive effects on labor productivity. Given this context, this paper assesses socioeconomic-differentials in the impact of out-of-pocket-health-expenditure (OOPHE) on impoverishment in China and India, two of the fastest growing economies of the world. The paper uses data from the World Health Organisation's Study on Global Ageing and Adult Health (WHO SAGE), and Bivariate as well as Multivariate analyses for investigating the socioeconomic-differentials in the impact of out-of-pocket-health-expenditure (OOPHE) on impoverishment in China and India. Annually, about 7% and 8% of the population in China and India, respectively, fall in poverty due to OOPHE. Also, the percentage shortfall in income for the population fro...
Journal of clinical and diagnostic research : JCDR, 2015
Impaction of maxillary canines is a frequently encountered clinical problem. The impaction of can... more Impaction of maxillary canines is a frequently encountered clinical problem. The impaction of canine can be prevented in some situationsif the canine displacement is diagnosed in the early mixed dentition period and this would be extremely useful for the clinician. Hence,it is very important to focus on the means of early diagnosis and interception of this clinical situation. In the present article, the differentmodalities used to diagnose the impacted canine are reviewed with an insight into current 3-D modalities.
Indian Journal of Applied Research, 2011
Current Biotechnology, 2013
ABSTRACT To overcome food borne illness, food quality and safety are major scientific disciplines... more ABSTRACT To overcome food borne illness, food quality and safety are major scientific disciplines including food handling, preparation and storage. Detection of contaminants in the food system is the main concern regarding public health. It is necessary to develop an immunoassay system to detect and control food borne pathogens in contaminated foods before they enter into the human food chain and cause infections. The conventional methods including agar plating, chromatography or immunoassay are tedious and time consuming for detection of food contamination, while biosensors are one option to overcome these problems. There is growing interest towards biosensors technology due to high specificity, convenience and quick response. In the field of food science and technology, biosensors technology for the detection of food borne pathogens is more fascinating to the current researchers. In this contest we introduce, quartz crystal microbalance (QCM) a label free and piezoelectric biosensor for the detection of pathogenic microbes and toxins present in the food. The potential significance of the present review is to provide the implementation of QCM based biosensor for the detection of various analytes in food systems including toxic and nontoxic.
International Journal of Aeroacoustics, 2009
ABSTRACT Average shock spacing and average standing wavelength are estimated from computed near-f... more ABSTRACT Average shock spacing and average standing wavelength are estimated from computed near-field of axisymmetric underexpanded screeching jets at low supersonic Mach numbers. These are used to predict screech frequencies based on existing formulations which rely ...
Current Breast Cancer Reports, 2013
The analysis of biomarkers in breast cancer has made a large impact in treatment decisions and de... more The analysis of biomarkers in breast cancer has made a large impact in treatment decisions and determining prognosis. Information gained from the phenotypic and molecular profile helps both in prognostic stratification as well as treatment selection. With the advent of newer more efficacious chemotherapeutic and biological agents in the management of metastatic breast cancer, most women with this disease are exposed to multiple lines of therapy. Discordance in the receptor status between the primary and metastatic sites is frequently encountered and may play an important role in deciding subsequent therapy. In this review, we look at the role of current biomarkers in the management of breast cancer, which are promising and the therapeutic and prognostic implications of their discordance during the natural course of disease progression.
Singapore Medical Journal, 2013
Mesothelioma is a slow-growing insidious lesion of neoplastic aetiology arising from the pleural,... more Mesothelioma is a slow-growing insidious lesion of neoplastic aetiology arising from the pleural, peritoneal or pericardial mesothelium. It shows a predilection for the surfaces of the pelvic viscera and has a high rate of recurrence after excision. Cystic mesotheliomas are not associated with asbestos exposure. We report a case of cystic mesothelioma of the peritoneum encasing the ovary, which presented as a cystic adnexal mass. As highlighted in this case and other recent reports, a cystic mesothelioma should not be referred to as a benign cystic mesothelioma, as it has potential for locoregional invasion, as well as distant nodal and serosal metastases. This tumour should be treated with aggressive cytoreductive surgery and appropriate chemotherapy. We review the differential diagnosis of this rare entity and suggest guidelines for its differentiation.
PloS one, 2015
The provision of affordable health care is generally considered a fundamental goal of a welfare s... more The provision of affordable health care is generally considered a fundamental goal of a welfare state. In addition to its role in maintaining and improving the health status of individuals and households, it impacts the economic prosperity of a society through its positive effects on labor productivity. Given this context, this paper assesses socioeconomic-differentials in the impact of out-of-pocket-health-expenditure (OOPHE) on impoverishment in China and India, two of the fastest growing economies of the world. The paper uses data from the World Health Organisation's Study on Global Ageing and Adult Health (WHO SAGE), and Bivariate as well as Multivariate analyses for investigating the socioeconomic-differentials in the impact of out-of-pocket-health-expenditure (OOPHE) on impoverishment in China and India. Annually, about 7% and 8% of the population in China and India, respectively, fall in poverty due to OOPHE. Also, the percentage shortfall in income for the population fro...
Food and nutrition bulletin, 2014
Information on the association between household food insecurity and nutritional status of childr... more Information on the association between household food insecurity and nutritional status of children and women based on a nationally representative sample is not available from Nepal. To examine the association between food insecurity and nutritional status of children and married women in Nepal using data from the 2011 Nepal Demographic and Health Survey. The Household Food Insecurity Access Scale was used to assess food insecurity in the 2011 Nepal Demographic and Health Survey. We used body mass index (BMI) to assess the nutritional status of married women, and stunting, wasting, and underweight to assess the nutritional status of children under 5 years of age. Binary logistic regression and multinomial logistic regression were performed to examine the associations. In severely food-insecure households, 51% of children were stunted and 40% were underweight; 27% of married women had a BMI below 18.5 kg/m2; children were 1.50 (95% CI, 1.15 to 1.97) and 1.40 (95% CI, 1.05 to 1.85) ti...
Journal of clinical and diagnostic research : JCDR, 2015
Impaction of maxillary canines is a frequently encountered clinical problem. The impaction of can... more Impaction of maxillary canines is a frequently encountered clinical problem. The impaction of canine can be prevented in some situationsif the canine displacement is diagnosed in the early mixed dentition period and this would be extremely useful for the clinician. Hence,it is very important to focus on the means of early diagnosis and interception of this clinical situation. In the present article, the differentmodalities used to diagnose the impacted canine are reviewed with an insight into current 3-D modalities.
Indian Journal of Applied Research, 2011
Journal of Radiology Case Reports, 2009
Tuberculosis (TB) of the scapula is an unusual presentation of musculoskeletal tuberculosis. In a... more Tuberculosis (TB) of the scapula is an unusual presentation of musculoskeletal tuberculosis. In an endemic area, this rare presentation may become more frequent. The indolent nature of tuberculous bone and joint disease often leads to delayed or missed diagnosis. It is not uncommon for this disease to mimic malignancy. Therefore, the prompt recognition of distinguishing features is vital for correct diagnosis. In particular, imaging is a key tool in helping to make the diagnosis, through the recognition of certain key radiological patterns. However, as there are no pathognomonic imaging findings, the diagnosis rests on histopathological and microbiological confirmation. We report a case of tuberculous osteomyelitis of the scapula. This entity has not received much attention in literature. Pure tuberculous osteomyelitis involving flat membranous bone, as depicted in this report, is rare. Our patient also had an ovarian malignancy, which had decreased our index of suspicion. We therefore present this case as tuberculosis masquerading a cystic scapular metastases.
Current Biotechnology, 2013
ABSTRACT To overcome food borne illness, food quality and safety are major scientific disciplines... more ABSTRACT To overcome food borne illness, food quality and safety are major scientific disciplines including food handling, preparation and storage. Detection of contaminants in the food system is the main concern regarding public health. It is necessary to develop an immunoassay system to detect and control food borne pathogens in contaminated foods before they enter into the human food chain and cause infections. The conventional methods including agar plating, chromatography or immunoassay are tedious and time consuming for detection of food contamination, while biosensors are one option to overcome these problems. There is growing interest towards biosensors technology due to high specificity, convenience and quick response. In the field of food science and technology, biosensors technology for the detection of food borne pathogens is more fascinating to the current researchers. In this contest we introduce, quartz crystal microbalance (QCM) a label free and piezoelectric biosensor for the detection of pathogenic microbes and toxins present in the food. The potential significance of the present review is to provide the implementation of QCM based biosensor for the detection of various analytes in food systems including toxic and nontoxic.
International Journal of Aeroacoustics, 2009
ABSTRACT Average shock spacing and average standing wavelength are estimated from computed near-f... more ABSTRACT Average shock spacing and average standing wavelength are estimated from computed near-field of axisymmetric underexpanded screeching jets at low supersonic Mach numbers. These are used to predict screech frequencies based on existing formulations which rely ...
Current Breast Cancer Reports, 2013
The analysis of biomarkers in breast cancer has made a large impact in treatment decisions and de... more The analysis of biomarkers in breast cancer has made a large impact in treatment decisions and determining prognosis. Information gained from the phenotypic and molecular profile helps both in prognostic stratification as well as treatment selection. With the advent of newer more efficacious chemotherapeutic and biological agents in the management of metastatic breast cancer, most women with this disease are exposed to multiple lines of therapy. Discordance in the receptor status between the primary and metastatic sites is frequently encountered and may play an important role in deciding subsequent therapy. In this review, we look at the role of current biomarkers in the management of breast cancer, which are promising and the therapeutic and prognostic implications of their discordance during the natural course of disease progression.
Food and nutrition bulletin, 2014
Information on the association between household food insecurity and nutritional status of childr... more Information on the association between household food insecurity and nutritional status of children and women based on a nationally representative sample is not available from Nepal. To examine the association between food insecurity and nutritional status of children and married women in Nepal using data from the 2011 Nepal Demographic and Health Survey. The Household Food Insecurity Access Scale was used to assess food insecurity in the 2011 Nepal Demographic and Health Survey. We used body mass index (BMI) to assess the nutritional status of married women, and stunting, wasting, and underweight to assess the nutritional status of children under 5 years of age. Binary logistic regression and multinomial logistic regression were performed to examine the associations. In severely food-insecure households, 51% of children were stunted and 40% were underweight; 27% of married women had a BMI below 18.5 kg/m2; children were 1.50 (95% CI, 1.15 to 1.97) and 1.40 (95% CI, 1.05 to 1.85) ti...
Journal of Radiology Case Reports, 2009
Tuberculosis (TB) of the scapula is an unusual presentation of musculoskeletal tuberculosis. In a... more Tuberculosis (TB) of the scapula is an unusual presentation of musculoskeletal tuberculosis. In an endemic area, this rare presentation may become more frequent. The indolent nature of tuberculous bone and joint disease often leads to delayed or missed diagnosis. It is not uncommon for this disease to mimic malignancy. Therefore, the prompt recognition of distinguishing features is vital for correct diagnosis. In particular, imaging is a key tool in helping to make the diagnosis, through the recognition of certain key radiological patterns. However, as there are no pathognomonic imaging findings, the diagnosis rests on histopathological and microbiological confirmation. We report a case of tuberculous osteomyelitis of the scapula. This entity has not received much attention in literature. Pure tuberculous osteomyelitis involving flat membranous bone, as depicted in this report, is rare. Our patient also had an ovarian malignancy, which had decreased our index of suspicion. We therefore present this case as tuberculosis masquerading a cystic scapular metastases.
Singapore Medical Journal, 2013
Mesothelioma is a slow-growing insidious lesion of neoplastic aetiology arising from the pleural,... more Mesothelioma is a slow-growing insidious lesion of neoplastic aetiology arising from the pleural, peritoneal or pericardial mesothelium. It shows a predilection for the surfaces of the pelvic viscera and has a high rate of recurrence after excision. Cystic mesotheliomas are not associated with asbestos exposure. We report a case of cystic mesothelioma of the peritoneum encasing the ovary, which presented as a cystic adnexal mass. As highlighted in this case and other recent reports, a cystic mesothelioma should not be referred to as a benign cystic mesothelioma, as it has potential for locoregional invasion, as well as distant nodal and serosal metastases. This tumour should be treated with aggressive cytoreductive surgery and appropriate chemotherapy. We review the differential diagnosis of this rare entity and suggest guidelines for its differentiation.
PloS one, 2015
The provision of affordable health care is generally considered a fundamental goal of a welfare s... more The provision of affordable health care is generally considered a fundamental goal of a welfare state. In addition to its role in maintaining and improving the health status of individuals and households, it impacts the economic prosperity of a society through its positive effects on labor productivity. Given this context, this paper assesses socioeconomic-differentials in the impact of out-of-pocket-health-expenditure (OOPHE) on impoverishment in China and India, two of the fastest growing economies of the world. The paper uses data from the World Health Organisation's Study on Global Ageing and Adult Health (WHO SAGE), and Bivariate as well as Multivariate analyses for investigating the socioeconomic-differentials in the impact of out-of-pocket-health-expenditure (OOPHE) on impoverishment in China and India. Annually, about 7% and 8% of the population in China and India, respectively, fall in poverty due to OOPHE. Also, the percentage shortfall in income for the population fro...
Journal of clinical and diagnostic research : JCDR, 2015
Impaction of maxillary canines is a frequently encountered clinical problem. The impaction of can... more Impaction of maxillary canines is a frequently encountered clinical problem. The impaction of canine can be prevented in some situationsif the canine displacement is diagnosed in the early mixed dentition period and this would be extremely useful for the clinician. Hence,it is very important to focus on the means of early diagnosis and interception of this clinical situation. In the present article, the differentmodalities used to diagnose the impacted canine are reviewed with an insight into current 3-D modalities.
Indian Journal of Applied Research, 2011
Current Biotechnology, 2013
ABSTRACT To overcome food borne illness, food quality and safety are major scientific disciplines... more ABSTRACT To overcome food borne illness, food quality and safety are major scientific disciplines including food handling, preparation and storage. Detection of contaminants in the food system is the main concern regarding public health. It is necessary to develop an immunoassay system to detect and control food borne pathogens in contaminated foods before they enter into the human food chain and cause infections. The conventional methods including agar plating, chromatography or immunoassay are tedious and time consuming for detection of food contamination, while biosensors are one option to overcome these problems. There is growing interest towards biosensors technology due to high specificity, convenience and quick response. In the field of food science and technology, biosensors technology for the detection of food borne pathogens is more fascinating to the current researchers. In this contest we introduce, quartz crystal microbalance (QCM) a label free and piezoelectric biosensor for the detection of pathogenic microbes and toxins present in the food. The potential significance of the present review is to provide the implementation of QCM based biosensor for the detection of various analytes in food systems including toxic and nontoxic.
International Journal of Aeroacoustics, 2009
ABSTRACT Average shock spacing and average standing wavelength are estimated from computed near-f... more ABSTRACT Average shock spacing and average standing wavelength are estimated from computed near-field of axisymmetric underexpanded screeching jets at low supersonic Mach numbers. These are used to predict screech frequencies based on existing formulations which rely ...
Current Breast Cancer Reports, 2013
The analysis of biomarkers in breast cancer has made a large impact in treatment decisions and de... more The analysis of biomarkers in breast cancer has made a large impact in treatment decisions and determining prognosis. Information gained from the phenotypic and molecular profile helps both in prognostic stratification as well as treatment selection. With the advent of newer more efficacious chemotherapeutic and biological agents in the management of metastatic breast cancer, most women with this disease are exposed to multiple lines of therapy. Discordance in the receptor status between the primary and metastatic sites is frequently encountered and may play an important role in deciding subsequent therapy. In this review, we look at the role of current biomarkers in the management of breast cancer, which are promising and the therapeutic and prognostic implications of their discordance during the natural course of disease progression.
Singapore Medical Journal, 2013
Mesothelioma is a slow-growing insidious lesion of neoplastic aetiology arising from the pleural,... more Mesothelioma is a slow-growing insidious lesion of neoplastic aetiology arising from the pleural, peritoneal or pericardial mesothelium. It shows a predilection for the surfaces of the pelvic viscera and has a high rate of recurrence after excision. Cystic mesotheliomas are not associated with asbestos exposure. We report a case of cystic mesothelioma of the peritoneum encasing the ovary, which presented as a cystic adnexal mass. As highlighted in this case and other recent reports, a cystic mesothelioma should not be referred to as a benign cystic mesothelioma, as it has potential for locoregional invasion, as well as distant nodal and serosal metastases. This tumour should be treated with aggressive cytoreductive surgery and appropriate chemotherapy. We review the differential diagnosis of this rare entity and suggest guidelines for its differentiation.
PloS one, 2015
The provision of affordable health care is generally considered a fundamental goal of a welfare s... more The provision of affordable health care is generally considered a fundamental goal of a welfare state. In addition to its role in maintaining and improving the health status of individuals and households, it impacts the economic prosperity of a society through its positive effects on labor productivity. Given this context, this paper assesses socioeconomic-differentials in the impact of out-of-pocket-health-expenditure (OOPHE) on impoverishment in China and India, two of the fastest growing economies of the world. The paper uses data from the World Health Organisation's Study on Global Ageing and Adult Health (WHO SAGE), and Bivariate as well as Multivariate analyses for investigating the socioeconomic-differentials in the impact of out-of-pocket-health-expenditure (OOPHE) on impoverishment in China and India. Annually, about 7% and 8% of the population in China and India, respectively, fall in poverty due to OOPHE. Also, the percentage shortfall in income for the population fro...
Food and nutrition bulletin, 2014
Information on the association between household food insecurity and nutritional status of childr... more Information on the association between household food insecurity and nutritional status of children and women based on a nationally representative sample is not available from Nepal. To examine the association between food insecurity and nutritional status of children and married women in Nepal using data from the 2011 Nepal Demographic and Health Survey. The Household Food Insecurity Access Scale was used to assess food insecurity in the 2011 Nepal Demographic and Health Survey. We used body mass index (BMI) to assess the nutritional status of married women, and stunting, wasting, and underweight to assess the nutritional status of children under 5 years of age. Binary logistic regression and multinomial logistic regression were performed to examine the associations. In severely food-insecure households, 51% of children were stunted and 40% were underweight; 27% of married women had a BMI below 18.5 kg/m2; children were 1.50 (95% CI, 1.15 to 1.97) and 1.40 (95% CI, 1.05 to 1.85) ti...
Journal of clinical and diagnostic research : JCDR, 2015
Impaction of maxillary canines is a frequently encountered clinical problem. The impaction of can... more Impaction of maxillary canines is a frequently encountered clinical problem. The impaction of canine can be prevented in some situationsif the canine displacement is diagnosed in the early mixed dentition period and this would be extremely useful for the clinician. Hence,it is very important to focus on the means of early diagnosis and interception of this clinical situation. In the present article, the differentmodalities used to diagnose the impacted canine are reviewed with an insight into current 3-D modalities.
Indian Journal of Applied Research, 2011
Journal of Radiology Case Reports, 2009
Tuberculosis (TB) of the scapula is an unusual presentation of musculoskeletal tuberculosis. In a... more Tuberculosis (TB) of the scapula is an unusual presentation of musculoskeletal tuberculosis. In an endemic area, this rare presentation may become more frequent. The indolent nature of tuberculous bone and joint disease often leads to delayed or missed diagnosis. It is not uncommon for this disease to mimic malignancy. Therefore, the prompt recognition of distinguishing features is vital for correct diagnosis. In particular, imaging is a key tool in helping to make the diagnosis, through the recognition of certain key radiological patterns. However, as there are no pathognomonic imaging findings, the diagnosis rests on histopathological and microbiological confirmation. We report a case of tuberculous osteomyelitis of the scapula. This entity has not received much attention in literature. Pure tuberculous osteomyelitis involving flat membranous bone, as depicted in this report, is rare. Our patient also had an ovarian malignancy, which had decreased our index of suspicion. We therefore present this case as tuberculosis masquerading a cystic scapular metastases.
Current Biotechnology, 2013
ABSTRACT To overcome food borne illness, food quality and safety are major scientific disciplines... more ABSTRACT To overcome food borne illness, food quality and safety are major scientific disciplines including food handling, preparation and storage. Detection of contaminants in the food system is the main concern regarding public health. It is necessary to develop an immunoassay system to detect and control food borne pathogens in contaminated foods before they enter into the human food chain and cause infections. The conventional methods including agar plating, chromatography or immunoassay are tedious and time consuming for detection of food contamination, while biosensors are one option to overcome these problems. There is growing interest towards biosensors technology due to high specificity, convenience and quick response. In the field of food science and technology, biosensors technology for the detection of food borne pathogens is more fascinating to the current researchers. In this contest we introduce, quartz crystal microbalance (QCM) a label free and piezoelectric biosensor for the detection of pathogenic microbes and toxins present in the food. The potential significance of the present review is to provide the implementation of QCM based biosensor for the detection of various analytes in food systems including toxic and nontoxic.
International Journal of Aeroacoustics, 2009
ABSTRACT Average shock spacing and average standing wavelength are estimated from computed near-f... more ABSTRACT Average shock spacing and average standing wavelength are estimated from computed near-field of axisymmetric underexpanded screeching jets at low supersonic Mach numbers. These are used to predict screech frequencies based on existing formulations which rely ...
Current Breast Cancer Reports, 2013
The analysis of biomarkers in breast cancer has made a large impact in treatment decisions and de... more The analysis of biomarkers in breast cancer has made a large impact in treatment decisions and determining prognosis. Information gained from the phenotypic and molecular profile helps both in prognostic stratification as well as treatment selection. With the advent of newer more efficacious chemotherapeutic and biological agents in the management of metastatic breast cancer, most women with this disease are exposed to multiple lines of therapy. Discordance in the receptor status between the primary and metastatic sites is frequently encountered and may play an important role in deciding subsequent therapy. In this review, we look at the role of current biomarkers in the management of breast cancer, which are promising and the therapeutic and prognostic implications of their discordance during the natural course of disease progression.
Food and nutrition bulletin, 2014
Information on the association between household food insecurity and nutritional status of childr... more Information on the association between household food insecurity and nutritional status of children and women based on a nationally representative sample is not available from Nepal. To examine the association between food insecurity and nutritional status of children and married women in Nepal using data from the 2011 Nepal Demographic and Health Survey. The Household Food Insecurity Access Scale was used to assess food insecurity in the 2011 Nepal Demographic and Health Survey. We used body mass index (BMI) to assess the nutritional status of married women, and stunting, wasting, and underweight to assess the nutritional status of children under 5 years of age. Binary logistic regression and multinomial logistic regression were performed to examine the associations. In severely food-insecure households, 51% of children were stunted and 40% were underweight; 27% of married women had a BMI below 18.5 kg/m2; children were 1.50 (95% CI, 1.15 to 1.97) and 1.40 (95% CI, 1.05 to 1.85) ti...
Journal of Radiology Case Reports, 2009
Tuberculosis (TB) of the scapula is an unusual presentation of musculoskeletal tuberculosis. In a... more Tuberculosis (TB) of the scapula is an unusual presentation of musculoskeletal tuberculosis. In an endemic area, this rare presentation may become more frequent. The indolent nature of tuberculous bone and joint disease often leads to delayed or missed diagnosis. It is not uncommon for this disease to mimic malignancy. Therefore, the prompt recognition of distinguishing features is vital for correct diagnosis. In particular, imaging is a key tool in helping to make the diagnosis, through the recognition of certain key radiological patterns. However, as there are no pathognomonic imaging findings, the diagnosis rests on histopathological and microbiological confirmation. We report a case of tuberculous osteomyelitis of the scapula. This entity has not received much attention in literature. Pure tuberculous osteomyelitis involving flat membranous bone, as depicted in this report, is rare. Our patient also had an ovarian malignancy, which had decreased our index of suspicion. We therefore present this case as tuberculosis masquerading a cystic scapular metastases.