PURPOSE: We analyzed the sonographic, CT, and MRI findings in acquired immune deficiency syndrome (AIDS)-related non-Hodgkin's lymphoma (NHL) of the liver to evaluate the role of sonography in the diagnosis of this disease. METHODS: We retrospectively reviewed sonograms and CT scans on 26 patients who had human immunodeficiency virus with liver lymphoma, either primary (10 cases) or secondary (16 cases), from 1992 to 1999. We also reviewed MR images on 12 of the patients. All patients had pathologically proven NHL; all imaging studies were obtained within 2 weeks of sonographically guided fine-needle aspiration biopsies. Lymphoma was the initial AIDS-defining illness in 38% of the patients. RESULTS: NHL occurred as multiple lesions in most cases of both primary (7 of 10 cases) and secondary (15 of 16 cases) liver lymphoma. No imaging finding was specific for the diagnosis of hepatic lymphoma. The hepatic lesions were hypoechoic in 25 of 26 cases; in the remaining case, there was a large isoechoic mass. On unenhanced and contrast-enhanced CT, the lesions were hypodense in all cases, with a thin enhancing rim in 6 patients. On MRI, the lesions were hypointense on T1-weighted images and hyperintense on T2-weighted images. CONCLUSIONS: Sonography may be helpful in the diagnosis of focal hepatic lymphoma in patients with human immunodeficiency virus. Sonographically guided fine-needle aspiration biopsy provides a definitive diagnosis. CT was crucial in the staging of lymphoma. MRI appears appropriate for studying liver NHL in selected cases.

Adult↗

PubMedDate not supplied

Serum alpha-L-fucosidase: a new marker for the diagnosis of primary hepatic carcinoma?

alpha-L-fucosidase, a lysosomal enzyme which catabolizes fucoproteins, was studied in sera from 30 controls, 32 patients with primary hepatic carcinomas, 24 patients with secondary metastatic liver carcinomas and 36 patients with cirrhosis. Serum alpha-L-fucosidase was increased in primary hepatic carcinomas (145.5 +/- 12 nkat per liter) with a high statistical significance versus controls (51.4 +/- 4.5 - p less than 10(-7], secondary metastatic liver carcinomas (58.9 +/- 6.4 - p less than 10(-5] and cirrhotics (71.3 +/- 6 - p less than 10(-5). A level exceeding 110 was a useful marker for the diagnosis of primary hepatic carcinoma with 75% sensitivity and 90% specificity.

Adenocarcinoma↗

PubMedDate not supplied

Three-dimensional low dose gadolinium-enhanced peripheral MR venography.

Our initial experience with low dose contrast-enhanced (LCE) peripheral MR venography (MRV) is presented. Five subjects were studied using three-dimensional (3D) fast imaging with a steady-state precession (FISP) sequence. A dose of 60 ml of gadopentetate dimeglumine diluted 1:20 was used. A tourniquet was applied during lower extremity MR venography. The venous anatomy was well depicted with the 3D LCE technique in all subjects. Compared to the two-dimensional (2D) time-of-flight (TOF) technique, acquisition time of 3D LCE MRV was much shorter, images looked sharper, and more veins could be seen. It is not affected by in-plane saturation and can be performed repeatedly because of the low dose of contrast. This technique holds promise for the detection of venous thrombosis and other disorders.

Adult↗

PubMedDate not supplied

Low penetrant hemochromatosis phenotype in eight families: no evidence of modifiers in the MHC region.

The gene responsible for hemochromatosis (HFE) has been identified on the short arm of chromosome 6, 4.5 Mb telomeric to HLA-A. A major mutation C282Y is closely correlated with the disease, as it accounts for 68 to 100\% of the cases of hemochromatosis. Nevertheless, some C282Y homozygotes subjects have no clinical or biological expression of the disease. Moreover, in Northern European populations a large discrepancy is observed between the number of C282Y homozygotes and the number of diagnosed hemochromatosis patients, suggesting incomplete penetrance of the mutation. To localize and identify the modifying genes, we investigated eight families including C282Y homozygous relatives showing no clinical signs of the disease, in addition to the hemochromatosis patients. Genomic DNA from 20 C282Y homozygotes (10 patients and 10 siblings presenting no or minor biological abnormalities) were studied. Five polymorphisms from the HFE gene were determined by PCR restriction. Extended haplotypes of the 6p21.3 region were constructed with 10 microsatellite markers. All the C282Y homozygotes shared the same HFE polymorphism. The haplotypes presented no significant difference between the probands and their unaffected relatives. These studies suggest that neither HFE polymorphism nor genes surrounding HFE are able to modulate HFE expression.

Adult↗

PubMedDate not supplied

Liquid extraction and HPLC-DAD assay of hydrochlorothiazide from plasma for a bioequivalence study at the lowest therapeutic dose.

The main parameters considered in optimizing the liquid extraction and quantitative assay were the yield, precision, limit of quantification, time required for extraction and concentration, and quantity of solvent. The influence on these parameters of the following factors was examined: nature of the extracting solvent, quantity of solvent, co-extraction solvent, and duration of stirring. Instead of equilibrium parameters of the involved thermodynamic system, a kinetic approach was preferred in terms of the effective partition 'constant', which is not really constant but a function of time and extraction conditions. The final selected method, considered to be rapid and simple, was applied to determine the pharmacokinetics of hydrochlorotiazide (HCT) after administration of Capozide (Bristol-Myers Squibb) tablets containing 50 mg Captopril and 25 mg HCT, to 4 healthy volunteers. The results obtained were in accordance with the pharmacokinetic parameters of HCT reported in the literature.

Chromatography, High Pressure Liquid↗

PubMedDate not supplied

Infectious spondylodiscitis: magnetic resonance imaging in HIV-infected and HIV-uninfected patients.

OBJECTIVE: We retrospectively reviewed 21 infections of the spine to correlate magnetic resonance imaging (MRI) with etiology of spondylodiscitis according to HIV status. CONCLUSION: MRI allowed the differentiation between tuberculous and pyogenic spondylodiscitis in the chronic stage. Typical findings were not observed in HIV+ as compared with HIV- patients, either concerning etiology or characteristic features of the spondylodiscitis.

Adult↗

PubMedDate not supplied

Detection of sentinel node in breast cancer: pilot study with the imaging probe.

The commonly used gamma probes are easy to use but also give rough information when employed in radioisotope-guided surgery. When images are required for exact localization, a gamma camera as well as a probe have to be used. Position-sensitive photomultipliers have contemporaneously allowed high-resolution scintigraphy and miniaturization of gamma cameras. We have assembled a miniature gamma camera with a 1-square-inch field of view and an intrinsic resolution of about 1 mm. When the minicamera is collimated with a large-holed, highly sensitive collimator, it acquires a spatial resolution of 3 mm. This prototype has been tested in the detection of difficult-to-image breast cancer sentinel nodes. Five nodes that had not been found with the usual technique of an Anger camera plus conventional probe were checked with the miniature camera that we named imaging probe: it actually is small enough to be used as a probe and large enough to give an image. One of the five nodes was found and imaged. It was small, disease-free, close to the tumor and probably hidden by the Compton halo around the peritumoral injection site. Our pilot study shows that the imaging probe, although still a prototype, has certain advantages over conventional methods when lymph node localization is required during surgery.

Breast Neoplasms↗

PubMedDate not supplied

Sentinel node detection with imaging probe.

A once-square-inch-field-of-view mini gamma camera, whose first prototype was built by us in 1998 and given the name imaging probe (IP), was initially employed in sentinel lymph node (SLN) detection. This is probably the best way of learning how to use it. In the present work IP was used for SLN localization by a medical team that, after having been trained by the group of nuclear physicians of "La Sapienza" University who designed and first used the detector, used IP at their own hospital to 1) acquire experience for future use during surgery (a cooperative project on IP-radioguided orthopedic surgery is ongoing) and 2) start multicenter trials with IP. The SLN was identified and localized with IP and a non-imaging probe, Neoprobe 2000, in six patients with breast cancer who underwent lymphoscintigraphy for SLN biopsy. The operators who used Neoprobe and IP were blinded to each other's findings and to the results obtained with the large-field-of-view Anger camera that was used for lymphoscintigraphy. The Anger camera, IP and Neoprobe detected seven SLNs in six patients. The mean detection time was 2 mins 6 s (standard deviation (SD) 26 s) with IP, and 2 mins 18 s (SD 47 s) with Neoprobe 2000. The SLN that was most difficult to find was detected in 2 mins 56 s with IP and 3 mins 45 s with Neoprobe. The operators' subjective impression of having detected the SLN was "absolutely sure" for 7/7 nodes with IP and "absolutely sure" for 5/7 nodes with Neoprobe.

Breast Neoplasms↗

PubMedDate not supplied

Clinical use of an imaging probe in breast cancer surgery.

AIMS: Portable cameras allow easy transfer of the detector, and thus of radioisotope imaging, to the operating room. In this paper we describe our preliminary experience in radionuclide imaging of breast cancer with a 22.8 x 22.8 mm(2) field-of-view minicamera called "Imaging Probe" (IP). METHODS: Breast cancer detection by IP was performed to guide biopsy, in particular open biopsy, or help fine-needle or core-needle positioning when the main guidance method was ultrasonography or digital radiography. 99mTc Sestamibi (MIBI) was injected 1 h before imaging and biopsy to 14 patients with suspected or known breast cancer. Scintigraphic images were acquired before and after biopsy in each patient. The surgeon was allowed to take into account scintigraphic images as well as previously performed mammograms and ultrasonography. RESULTS: High-resolution IP images were able to guide biopsy toward cancer or toward washout zones of cancer which are thought to be chemoresistant in seven patients out of 10. Four patients in whom IP and MIBI were unable to guide biopsy were found not to have cancer. CONCLUSIONS: Our study confirms the ability of IP to guide breast biopsy even when our minicamera has to be handled manually by trained physicians during surgery.

Breast Neoplasms↗

PubMedDate not supplied

New localization technique for breast cancer biopsy: mammotome guidance with imaging probe.

AIMS AND BACKGROUND: The "Imaging Probe" (IP) is a small, portable, high-resolution gamma camera to be used in radioguided surgery. The present work discusses a special prototype designed for guiding biopsies. The IP was mounted to a Fischer digital X-ray stereotactic core biopsy system in such a way that biopsy could be guided simultaneously by X-ray stereotaxis and 99mTc-Sestamibi (MIBI) images from IP. METHODS: The IP field of view was 22.8 x 22.8 mm(2), with a spatial resolution of approx. 2.5 mm. We used off-line software for image fusion on a dedicated Pentium III portable PC. It was matched with a Fischer digital X-ray stereotactic biopsy system dedicated to direct the mammotome towards breast opacities. The operator was allowed to slightly correct the direction of the mammotome needle taking into account stereotactic X-ray, scintigraphic and fused images. Biopsy samples were counted by IP before they were sent to the pathologist. RESULTS: High-resolution IP scintigraphy showed substantial, though not exact, matching between MIBI hot spots and X-ray opacities. More than one hot spot was detected even in the smallest (0.6 cm) lesion. Post-biopsy scintigraphy showed absence of significant hot spots in two patients, whereas in the third patient one of the three hot spots was still partially present. All lesions showed cancer on histological examination. CONCLUSIONS: Measurement of radioactivity in biopsy specimens confirmed the heterogeneous distribution of radioactivity within cancers that IP had detected before biopsy.

Biopsy, Needle↗

PubMedDate not supplied

99m Tc MIBI prone scintimammography in breast Paget's disease: a case report.

A 99m Tc MIBI prone scintimammography (PSM) was performed in a case of underlying Paget's disease of the breast. 99m Tc MIBI PSM showed a diffuse scintigraphic image like a spread of uptake from the deeply located zones of the breast toward epidermis. In vivo, 99m Tc MIBI PSM represents the spread of neoplastic Paget's cells probably attracted by chemotactic factors released by keratinocytes. This spread in Paget's disease is correlated to neu oncogene overexpression which increases the metastatic activity as a consequence of motility enhancement and growth stimulation effect. These scintigraphic images suggest that 99m Tc MIBI PSM could be relevant in management of Paget's disease of the breast.

Biomarkers, Tumor↗

PubMedDate not supplied

Radiology of abdominal pain.

Radiology plays an integral role in the evaluation of patients with significant abdominal pain. The cross-sectional modalities (computed tomography, ultrasound, and magnetic resonance imaging) are widely used, but there is sometimes confusion about how to use each test appropriately. We review how each test is done, consider the strengths and weaknesses of each modality, and discuss how to use them in an intelligent, cost-effective manner.

Abdominal Pain↗

PubMedDate not supplied

[Recommended algorithms of prescription in the diagnosis of iron deficiency and overload].

In view of the recent development of new tests of biochemistry and molecular biology the assessment of iron status should be reconsidered and updated. The French Society of Clinical Biology (SFBC) and the French Society of Hematology (Cellular Hematology Group) recommend algorithms in the diagnosis of iron deficiency and iron overload bearing in mind the best efficiency and health economy. These recommendations are based on the known sensibility and specificity of each test. The analytical requirements for the determination of the tests as well as the clinical and biological signs evoking an iron deficiency or overload are recalled.

Adult↗