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PubMed1996

[Acute torsion of an accessory spleen].

A case of acute torsion of an accessory spleen is reported. In a 15-year-old girl was admitted to hospital with acute abdominal pain. Ultrasonography showed a round, hypoechoic, solid mass. Computed tomography demonstrated a low-density mass with peripheral enhancement after intravenous contrast medium. These findings suggest the presence of a capsule. At laparotomy, the patient was found to have torsion and infarction of an accessory spleen. Sonographic and computed tomographic findings are discussed.

Acute Disease↗
PubMed2002

Alveolar adenoma of the lung: computed tomography and magnetic resonance imaging findings.

Alveolar adenoma of the lung is a rare benign neoplasm with distinctive gross and microscopic findings. Radiographically, alveolar adenoma usually presents as a well-circumscribed, peripheral, solitary nodule. The authors describe the contrast-enhanced computed tomography and magnetic resonance imaging features of alveolar adenoma of lung. Magnetic resonance imaging demonstrated the presence of a cystic space with central fluid and thin-rim enhancement. These findings are suggestive of a benign nodule, and alveolar adenoma of lung should be added to the differential diagnosis of nodules that demonstrate this pattern of enhancement and are probably benign.

Adenocarcinoma, Bronchiolo-Alveolar↗
PubMed1981

Discrimination in immunofluorescence between labeled and unlabeled cells by quantitative microfluorometry and computer analysis.

An automated procedure for discrimination in immunofluorescence between antibody-labeled and unlabeled cells has been developed on the basis of microfluorimetric determination of intensity distributions. After smoothing the raw data for irregularities caused by the scoring statistics optimum fit of the negative distribution to the corresponding positive one was achieved. The procedure was tested in a model system by mixing various known proportions of immunofluorescence-negative and -positive plastic beads. In addition, variable mixtures of T-negative CLL cells and normal mononuclear peripheral blood cells were labeled with FITC-conjugated anti-T-antiserum. The expected percentage of T-positive peripheral blood cells agreed satisfactorily with the data measured and computed. Finally, the measured percentage of Ig-positive mononuclear cells from normal peripheral blood was in agreement with the values obtained by other techniques.

Automation↗
PubMed1987

Mediastinal lymph node evaluation by computed tomography in lung cancer. An analysis of 345 patients grouped by TNM staging, tumor size, and tumor location.

To more clearly characterize the role of computed tomography in staging the mediastinal lymph nodes of patients with lung cancer, we analyzed computed tomographic and surgical findings in the chest in 345 consecutive patients with lung cancer who underwent operative staging. Patients were grouped according to the TNM staging system of the American Joint Commission, central or peripheral location of the primary tumor, lobar location of the tumor, and maximum tumor diameter as determined by computed tomography or gross pathology. One third of patients with abnormal findings on the computed tomographic scan did not have mediastinal lymph node metastases. Mediastinal metastases occurred frequently in patients with central cancers (38%). The predictive value of a negative scan in all patients was high (greater than or equal to 90%) except for patients with central T3 lesions (72%), left upper lobe lesions (83%), and central adenocarcinomas (75%). However, only the differences between central T3 and central T2 or T1 lesions, and between central adenocarcinomas and central squamous cell carcinomas, were unlikely to be due to chance alone (p less than 0.05). None of the lobar differences were statistically significant. The frequency of mediastinal metastases in patients with peripheral lesions was 15% (28 of 192 patients); computed tomography correctly identified enlarged mediastinal lymph nodes in all but seven patients. However, there were no true-positive computed tomographic scans in 59 patients with peripheral lesions 2 cm in diameter or smaller; accordingly, we suggest that computed tomography is not indicated for the sole purpose of mediastinal staging in this group. Ninety-four percent of patients in this series undergoing thoracotomy with a curative intent had a curative resection. Only 4% had unresectable lesions; palliative resections were done in 2%.

Adult↗
PubMed2003

8.0-Tesla human MR system: temperature changes associated with radiofrequency-induced heating of a head phantom.

PURPOSE: To investigate if the heat induced in biological tissues by typical radio frequency (RF) energy associated with an 8.0-Tesla magnetic resonance (MR) system causes excessive temperature changes. MATERIALS AND METHODS: Fluoroptic thermometry was used to measure temperatures in multiple positions in a head phantom made of ground turkey breast. A series of experiments were conducted with measurements obtained at RF power levels ranging from a specific absorption rate (SAR) of up to 4.0 W/kg for 10 minutes. RESULTS: The highest temperature increases were up to 0.7 degrees C. An inhomogeneous heating pattern was observed. In general, the deep regions within the phantom registered higher temperature increases compared to the peripheral sites. CONCLUSION: The expectation of an inhomogeneous RF distribution in ultra high field systems (> 4 T) was confirmed. At a frequency of 340 MHz and in-tissue RF wave length of about 10 cm, the RF inhomogeneity was measured to create higher temperatures in deeper regions of a human head phantom compared to peripheral tissues. Our results agree with the computational electromagnetic calculations for such frequencies. Importantly, these experiments indicated that there were no regions of heating that exceeded the current FDA guidelines.

Head↗
PubMed2001

Quantitative assessment of cutaneous thermal and vibration sensation and thermal pain detection thresholds in healthy children and adolescents.

Quantitative sensory testing (QST) is a noninvasive, computer-assisted method for assessing function in peripheral small and large sensory fibers. In order to use QST for clinical neurological assessment in children, it is necessary: (1) to determine whether children can reliably perform these tests and (2) to characterize normal ranges in healthy children. Values of cold sensation, warm sensation, cold pain, heat pain, and vibration sensation detection thresholds were determined in the hand and foot with the method of limits (MLI) and method of levels (MLE) in 101 healthy children aged 6-17 years using a commercially available device. Both MLI and MLE were well-accepted by children, and there was good reproducibility between two sessions. The MLE takes longer to perform but produces lower thermal detection thresholds than the MLI. In the MLI, vibration and warm sensation showed higher thresholds in the foot than hand, whereas cold pain showed lower thresholds in the foot than hand. Based on these results, QST may be used to document and monitor the clinical course of sensory abnormalities in children with neurological disorders or neuropathic pain.

Adolescent↗
PubMed1997

Transcephalic electrical impedance in the study of cerebral circulation in a juvenile pig model.

Transcephalic electrical impedance offers a technique for non-invasive, cot-side monitoring of neonatal cerebral circulation but the exact nature of the signal is somewhat ambiguous. The impedance signal is examined in an animal project where the ventilator settings are adjusted (20 min-1-10 min-1-40 min-1 for 10 min periods each) to produce circulatory changes. Six juvenile pigs are intubated, and ECG, arterial blood pressure, carotid flow (CF) by electromagnetic flowmeter and impedance are continuously monitored and stored on analogue tape. Cardiac output by thermodilution, blood oxygen (pO2) and carbon dioxide (pCO2) tensions are measured. ECG is converted to heart rate, mean blood pressure is integrated, and the high-frequency (1.50-4.00 Hz) component of the impedance signal delta Z is computed using autoregressive spectral estimation. Stroke volume, peripheral vascular resistance (PVR) and cerebral vascular resistance (CVR) are calculated. pCO2 and CF increase and pO2 decreases during hypoventilation. CF correlates positively with cardiac output, stroke volume, delta Z and pCO2, and negatively with pO2 and CVR. delta Z correlates positively with heart rate and cardiac output, and negatively with PVR and CVR. It is concluded that the impedance signal is related to the amount of blood transmitted to the brain by every beat of the heart, depending on the changes in both the systemic circulation and the cerebral vascular compliance.

Animals↗
PubMed2004

Awareness of osteoporosis among physicians in China.

Epidemiological studies have projected a vast increase in osteoporotic fractures in Asia, with the majority occurring in China. Awareness of osteoporosis among medical professionals and the pattern of management in Asia have not been explored. A total of 504 doctors in Hong Kong, China with their self-reported practice likely to receive clients with or at risk of osteoporosis were invited to complete a postal questionnaire on the diagnosis and management of their osteoporotic patients. In all, 204 questionnaires were returned, with a response rate of 41%. Only 76% of the respondents reported treating osteoporosis patients in their practice. Ninety-one percent believed that osteoporosis was under-diagnosed. The asymptomatic nature of the disease (66%), inaccessibility (45%) and high cost (54%) of the diagnostic tools were considered major reasons for under-diagnosis. DXA was employed for diagnosis by only 53% of the doctors. Peripheral machines such as ultrasound and quantitative computed tomography were used by 35% of the responders as the only diagnostic tool, especially among clinic-based doctors (clinic-based physicians 47%, hospital-based physicians 17%; P<0.001). Thirty-three percent of the surveyed doctors were unaware of published guidelines for bone mineral density (BMD) measurements. Concerning treatment goals, 82% considered prevention of future fractures and 66% believed improvement in the quality of life of patients as critical or highly important, whereas only about half of the doctors thought that increase in BMD was important. On the other hand, 60% of the doctors considered the cost of therapy a critical or highly important element in the management of osteoporosis. This study showed that physicians in Hong Kong were aware of osteoporosis, though the disease was still under-diagnosed due to inaccessibility and high cost of the diagnostic tools and therapeutic agents. These findings stress the importance of expanding efforts to increase knowledge and awareness among health care providers and also provide future directions for developing strategies for managing osteoporosis in developing Asian regions.

Absorptiometry, Photon↗
PubMed2004

Sickle beta-thalassemia presenting as orbital compression syndrome.

Orbital compression syndrome is caused by disorders of varying etiologies involving the orbit and presents with ocular and extraocular dysfunction. Ocular involvement of sickle cell disease is uncommon. A 17-year-old male presented with low backache and proptosis of both eyes of 5 days duration without past history of pain crisis or transfusion. Examination revealed pallor, icterus, bilateral proptosis, conjuctival chemosis, and symmetrical restriction of ocular movements with preserved visual acuity. He was drowsy with no other focal deficits. The fundus showed macular edema, venous engorgement, and no hemorrhage. His peripheral smear showed presence of sickle cells. Computed tomography (CT) scan of the orbit revealed orbital subperiosteal hematomas. CT head images showed epidural hematoma in the frontal lobe. High-performance liquid chromatography (HPLC) and mutation studies revealed sickle beta-thalassemia in the patient. He was managed with supportive care, transfusions to keep hemoglobin above 10 g/dl, and hydroxyurea. The patient recovered fully and remained well during follow-up of 12 months. Our case was unique for presenting as orbital compression syndrome without any history of vaso-occlusive crisis.

Adolescent↗
PubMed2005

Lobar and sublobar resection with and without brachytherapy for small stage IA non-small cell lung cancer.

OBJECTIVE: Computed tomographic screening is detecting ever smaller peripheral non-small cell lung cancers. These smaller cancers are amenable to sublobar resection, but sublobar resection is not currently the treatment of choice. This study compared sublobar resection with lobar resection for stage IA non-small cell lung cancers to assess whether sublobar resection is appropriate treatment for certain lesions. The use of adjuvant brachytherapy was also evaluated. METHODS: A retrospective multicenter study of 291 patients with T1 N0 disease was done. Outcomes after sublobar resection (n = 124) were compared with those after lobar resection (n = 167). Brachytherapy was used in conjunction with 60 (48%) sublobar resection operations. Analysis based on tumor diameter was performed. RESULTS: There were 137 cancers smaller than 2 cm and 154 cancers ranging from 2 to 3 cm. Patients undergoing sublobar resection were older (68.4 vs 66.1 years, P = .018) with poorer pulmonary function (forced expiratory volume in 1 second of 53.1% vs 78.2%, P = .001). Mean follow-up was 34.5 months. Brachytherapy decreased local recurrence rate significantly among patients undergoing sublobar resection, from 11 (17.2%) to 2 (3.3%). For tumors smaller than 2 cm, there was no difference in survival between sublobar resection and lobar resection groups. For the larger tumors (2-3 cm), median survival was significantly better in the lobar resection group, at 70 versus 44.7 months ( P = .003). CONCLUSION: Intraoperative brachytherapy may reduce the local recurrence that is usually reported with sublobar resection. Our experience supports the further investigation of the use of sublobar resection with brachytherapy for peripheral stage IA non-small cell lung cancers smaller than 2 cm.

Adenocarcinoma↗
PubMed1998

Occult lung cancer beyond bronchoscopic visibility in sputum-cytology positive patients.

Sputum cytology is useful for screening and diagnosis of centrally located lung cancer in Japan. On the other hand, cancer beyond the range of bronchoscopic visibility in X-ray negative patients can be detected only with difficulty. Of 265 patients detected by sputum cytology in mass screening, 85 had an abnormal chest roentgenogram and the remaining 180 were roentgenographically occult. A total of 200 roentgenographically occult squamous cell carcinoma lesions were detected in the above 180 patients. A total of 45 of the 200 lesions were bronchoscopically occult. Twenty-two of the above 45 lesions were beyond the range of bronchoscopic visibility with a standard bronchoscope. The data obtained show that a sputum cytology positive, X-ray negative squamous cell carcinoma may lie outside the reach of a flexible bronchoscope. Thus, when it is difficult to localize a cancer, brushing of the peripheral bronchi beyond bronchoscopic visibility and chest computed tomography should be performed.

Adult↗
PubMedDate not supplied

[Scintigraphy with thallium chloride in a case of clear cell sarcoma of the tendons and aponeurosis].

Clear cell sarcoma of the soft parts (CCSSP) is a rare and highly malignant tumor. This is a case report of a 31 years old woman who presented with a tumor in the internal face of left thigh. The tumor biopsy was suggestive of a possible malignant tumor of the peripheral nerve sheath (malignant schwannoma). Biochemical analyses, computed tomography and magnetic resonance were performed and reported a sarcoma of soft parts (CCSSP) without abnormal inguinal lymph nodes. With this diagnostic suspicion, the patient was sent to the Nuclear Medicine Service of our center where a 201Thallium scintigraphy study was performed. In this study, it showed the primary tumor together with a hot spot in the homolateral inguinal region, suggestive of the presence of a metastastic lymph node. This finding would change the surgical attitude in the patient, including inguinal lymphadenectomy. The post-surgical histological study confirmed a clear cell sarcoma of soft parts (CCSSP) with a metastatic inguinal lymph node.

Adult↗
PubMed2003

Isodose patterns in patients with inadequate prostate brachytherapy coverage.

PURPOSE: The development of a practical, real-time dosimetry system should result in improved implant dose distributions and higher prostate cancer control rates. Our purpose here is to demonstrate that intraoperative isodose reconstruction in relation to the seed distribution, even without accurate registration with the prostatic volume, can likely identify an inadequate implant intraoperatively and guide corrective seed placement. METHODS AND MATERIALS: A total of 102 Pd-103 implants performed by standard techniques, using a modified peripheral loading pattern, were studied. A postimplant computed tomography (CT) scan was obtained 2-4 h after the implant. The contoured images and sources were entered into a Varian Variseed 7.0 treatment planning system. Dosimetric parameters analyzed included the percent of the postimplant prostate or rectal volume covered by the prescription dose (V100), and the dose that covers 90% of the postimplant prostate volume (D90). Isodose patterns were analyzed at midprostate, and for the entire prostate. Adverse isodose patterns were defined as gaps, holes, islands. Isodose gaps are subprescription intervals between the prostatic margin and the prescription isodose. Isodose holes are regions of subprescription dose within the prostate. Isodose islands are isolated regions > or =prescription dose inside the prostatic margins. RESULTS: Characteristic isodose patterns were predictive for V100 values. Midprostatic isodose holes were seen in 55% of patients with a V100 < 80%, 5% of patients with a V100 of 80-90%, and only 1% of patients with a V100 > 90%. When analyzing the entire prostate, isodose holes were seen in 55% of patients with a V100 < 80%, 18% of patients with a V100 of 80-90%, and 9% of patients with a V100 > 90%. Midprostatic isodose islands were seen in 55% of patients with a V100 < 80%, 5% of patients with a V100 of 80-90%, and no patient with a V100 > 90%. When analyzing the entire prostate, isodose islands were seen in all patients with V100 < 80%, 36% of patients with a V100 of 80-90%, and only 1% of patients with a V100 > 90%. The likelihood of a V100 less than 80% was best predicted by the presence of isodose holes or islands at midprostate. Patients with either finding had an 86% chance of having a V100 < 80%. CONCLUSIONS: These semiquantitative findings can provide practical guidelines for intraoperative dosimetry, to provide a more rational guide to intraoperative postimplant assessment and modification. If isodose holes or islands are seen within the implanted volume, additional seeds are added to the affected region to obtain a V100 > 80%.

Brachytherapy↗
PubMedDate not supplied

Benign enlargement of peripheral subarachnoid spaces in twins.

A case of benign enlargement of peripheral subarachnoid spaces in twins is described. Computed tomography demonstrated identical findings, namely the enlargement of the sulci mainly in the frontal area bilaterally with slight dilatation of the ventricular system. Literature research did not reveal such a case in twins nor has any association of the situation with any genetic or family predisposition been found.

Cerebral Ventricles↗
PubMed2001

Preventing contrast-induced nephropathy with fenoldopam.

Fenoldopam is an interesting orphan drug that is a variant of dopamine. It differs significantly from dopamine in that it is a specific agonist for the type I (DA-1) receptor. The DA-1 receptors are particularly prominent in the renal vasculature, renal tubules, mesenteric vasculature, and peripheral vessels. The DA-1 receptor stimulation vasodilates renal and peripheral vessels, causing a decrease in blood pressure and an increase in renal blood flow (RBF). Stimulation of the DA-1 receptors in the tubules causes an increase in sodium excretion, which gives rise to an increase in urine volume on the basis of a sodium natriuresis. Animal testing with fenoldopam has indicated that it is 6 times more potent than dopamine in its ability to decrease renal vascular resistance and increase RBF; this suggests that it could be a much more selective and potent renal protective agent against any toxin or stimulus that causes renal dysfunction by reducing RBF or increasing renal ischemia. The clinical activity of fenoldopam, which is administered intravenously, begins almost immediately and is clearly noticeable after 5 minutes. The drug has no rebound effect, and its use can be stopped at any time. The protocol for the use of fenoldopam as a renal protective agent (performed at the University of Minnesota) involves starting an intravenous fenoldopam infusion 2 hours before the procedure at a rate of 0.1 microg/kg/min and increasing the dose in increments of 0.1 microg/kg/min every 20 minutes, until a rate of 0.5 microg/kg/min is reached or the systolic blood pressure falls more than 40 mm Hg (or below 110 mm Hg). Any infusion level at or above 0.1 microg/kg/min is considered acceptable because the response in individual patients varies so widely. The fenoldopam infusion is maintained at the maximum rate throughout the procedure and for up to 4 hours after the end of the contrast administration. At the University of Minnesota, we have had anecdotal experience using the drug in 29 patients. The drug was used for patients who were thought to be at the highest risk for contrast-induced nephropathy, ie, patients who have both diabetes and pre-existing renal failure. In this small group of patients in whom hydration and other variables were not controlled, there was a startling lack of contrast-induced creatinine increase at any point during the 24 to 48 hours after the administration of contrast in all but 1 patient. Our experience suggests that fenoldopam may be of distinct benefit to high-risk patients who need intravascular contrast, especially those who may receive a large contrast dose, such as patients undergoing peripheral or coronary angiography and intervention and/or computed tomography. Although it is impossible on the basis of simple anecdotal case reports to determine whether or not the drug was the primary reason that such a marked protective effect was seen, the results are promising enough to indicate that a careful, prospective, randomized trial of fenoldopam versus hydration is warranted.

Animals↗
PubMed1993

Multiple pulmonary-artery aneurysms due to mucoid vasculopathy--angiographic and histological observations.

Multiple peripheral pulmonary artery aneurysms were diagnosed by computed tomography and confirmed angiographically in a 7-year-old boy. On histological examination unusual mucoid vasculopathic changes were noted in the pulmonary artery aneurysms and pulmonary vasculature as a part of systemic vascular involvement. This case demonstrates a new association between mucoid vasculopathic changes and pulmonary aneurysms. Mucoid vasculopathy could represent one more disorder having a causative role in the etiology of intrapulmonary arterial aneurysms.

Aneurysm↗
PubMed2006

Severe carbon monoxide poisoning treated by hyperbaric oxygen therapy--a case report.

Carbon monoxide (CO) poisoning is an important cause of mortality and late neurological sequelae such as memory loss, personality changes, psychosis, dementia, and so on. The benefits of hyperbaric oxygen (HBO) therapy are still discussed, but the majority of trials recommend it in severe cases with coma and/or hemodynamic instability, irrespective of carboxyhemoglobin (COHb) level, to prevent permanent neurological deficits. We present a 35-yr-old woman who underwent accidental CO poisoning. Although breathing 100% oxygen by mask during transfer to the hospital, she was in deep coma, hypotensive, cyanotic, and hypoxic (arterial pO(2) 7,41 kPa, HbO(2) 87.8%), with serum COHb 26.7% on hospital admission. Orotracheal intubation, mechanical ventilation, iv fluids, dobutamin, and norepinephrine were administered. COHb level decreased to 17.2% within 1 h. To prevent severe neurological sequelae, the patient was transferred as soon as possible to an HBO center 60 km distant to perform HBO therapy twice at 3.0 and once at 2.2 atm within 24 h. After the second HBO session, the patient regained consciousness, and respiratory failure and shock resolved. She was transferred to our hospital and discharged few weeks later with discrete paresis of peripheral nerves, discrete ischemic brain lesions on computed tomography (CT) scan, and moderately abnormal electroencephalogram (EEG) without cognitive disturbances. She was able to resume her daily activities. We conclude that in severe CO poisoning, normobaric oxygen therapy and resuscitation by fluids, inotropic agents, and catecholamines is essential for survival, but additional HBO therapy seems to prevent major neurological sequelae.

Adult↗
PubMed2006

Solitary actinomycotic abscesses of liver: report of two cases.

Hepatic actinomycotic abscesses are rare and secondary to other intra-abdominal infections. History of intra-abdominal surgery is a principal contributing factor for the abscess formation. Patients with hepatic actinomycotic abscess may suffer from fever, malaise, abdominal pain and bodyweight loss. The clinical progress of actinomycotic abscess is more indolent than the usual course of other pyogenic abscess. It is sometimes diagnosed as malignancy. This report consists of two cases of hepatic actinomycotic abscess mimicking tumours. Laboratory data revealed elevated alkaline phosphatase and leucocytosis. The abdominal computed tomography scan showed multiloculated lesions with peripheral contrast enhancement appearance. Diagnosis confirmation was based on the typical histologic feature of sulfur granules with inflammatory process by echo-guided fine needle biopsy or surgical specimen. These two cases were resolved with extended courses of intravenous and oral penicillin treatment.

Actinomycosis↗