CT-guided percutaneous injection of fibrin glue for the therapy of symptomatic arachnoid cysts

BACKGROUND AND PURPOSE

Although often asymptomatic, enlarging sacral arachnoid cysts can also cause significant discomfort. These symptomatic sacral arachnoid cysts require specific treatments to facilitate local decompression. The main drawback of the surgical managements is the high risk of recurrence and complications. To decrease risks, we had been attempting to seek a simple and safe method to manage the symptomatic sacral arachnoid cysts. CT-guided percutaneous fibrin glue therapy is a new nonsurgical alternative. To evaluate the efficacy of the novel nonsurgical approach, we conducted this retrospective study of 38 patients.

MATERIALS AND METHODS

Thirty-eight patients with symptomatic sacral arachnoid cysts underwent fibrin glue therapy in our hospital between June 2006 and May 2009. The clinical results of improvement in pain and neurologic function were evaluated after an average of 25 months of follow-up, and changes on the imaging findings were evaluated. Preoperative and postoperative pain severity was assessed according to a 10-cm VAS. Moreover, we also analyzed the postoperative complications.

RESULTS

Most patients experienced some degree of pain relief and functional improvement after fibrin glue therapy, with most experiencing complete or marked resolution of clinical symptoms. Twenty-one patients (55.3%) reported excellent recovery, 12 (31.5%) reported good recovery, 4 (10.5%) reported fair recovery, and 1 (2.6%) reported poor recovery. The overall percentage of positive outcomes (excellent and good recovery) was 86.8%. No serious postoperative complications were discovered.

CONCLUSIONS

CT-guided percutaneous injection of fibrin glue therapy is simple, safe, and effective for the management of symptomatic sacral arachnoid cysts.

Clinical features of axial undifferentiated spondyloarthritis (USpA) in China: HLA-B27 is more useful for classification than MRI of the sacroiliac joint

OBJECTIVES

To analyse the clinical features of Chinese undifferentiated spondyloarthritis (USpA) patients with predominantly axial involvement, and in particular the influence of human leucocyte antigen (HLA)-B27 and magnetic resonance imaging (MRI) of the sacroiliac joint (SIJ) on the classification of axial USpA.

METHODS

Patients with low back pain for ≥ 3 months and no definite radiographic sacroiliitis were enrolled in this study. They were diagnosed as USpA based on rheumatologists' findings. Correlations between clinical features and HLA-B27 status or MRI manifestations were analysed.

RESULTS

A total of 197 USpA patients were recruited, of whom 135 (70.3%) were positive for HLA-B27. Acute inflammation, structural damage lesions, and normal findings on SIJ MRI were recorded in 64.5, 13.2 and 22.3% of patients, respectively. Classification criteria for axial SpA according to the European Spondylarthropathy Study Group (ESSG), Amor, and the Assessment of SpondyloArthritis International Society (ASAS) were fulfilled by 63.5, 64.5 and 83.2% patients, respectively. Cross-validation showed significant correlation among these three criteria. Patients positive for HLA-B27 included more males, with earlier onset age, better response to non-steroidal anti-inflammatory drugs (NSAIDs), and higher erythrocyte sedimentation rate (ESR)/C-reactive protein (CRP) levels. In addition, more HLA-B27-positive than HLA-B27-negative patients fulfilled the ESSG, Amor, and ASAS criteria. Patients with acute inflammation on SIJ MRI had a higher level of ESR/CRP, and a greater proportion of them fulfilled the Amor and ASAS criteria. However, the proportion of those fulfilling the ESSG criteria did not differ with different MRI manifestations.

CONCLUSION

Both HLA-B27 status and SIJ MRI findings influence the classification of Chinese axial USpA patients, but HLA-B27 seems of more value.

In vitro evaluation of the performance of Granada selective enrichment broth for the detection of group B streptococcal colonization

A broth for the screening of group B streptococcal (GBS) carriage during pregnancy is about to be introduced. Simulating conditions in everyday practice, we have compared the sensitivity of this Granada tube broth (GT) with that of classical Amies transport medium (AT) in vitro. A total of 1,485 GT and 1,485 AT were tested with 33 well-characterized GBS strains in three different concentrations, five different incubation times, and three different temperatures. After initial incubation at room temperature (RT) or 4°C, GT were placed at 37°C. GT were scored for the presence of orange pigment. GT and AT were subcultured on blood agar (BA). Pigment was observed in 98% of GT incubated at 37°C. GBS could be cultured in 91%, 73%, and 55% of GT incubated at 37°C, RT, or 4°C, respectively. For AT, these percentages were only 20% at 37°C, 52% at RT, and 59% at 4°C. When GT initially incubated at RT or 4°C were subsequently incubated at 37°C, the sensitivity improved significantly. We conclude that GT is a more sensitive GBS transport and culture medium than the conventional method, especially for low inocula and prolonged transport/incubation times. GT does not exclude the presence of GBS, and should always be incubated at 37°C and subcultured on solid agar for optimal sensitivity.

Polypeptide N-acetylgalactosaminyltransferase 6 expression in pancreatic cancer is an independent prognostic factor indicating better overall survival

BACKGROUND

The family of polypeptide N-acetylgalactosaminyltransferases (GalNAc-Ts) is responsible for the altered glycosylation in cancer. The purpose of our study was to investigate the clinical significance of two isoforms, GalNAc-T6 and -T3, and their correlation with the prognosis of pancreatic cancer.

METHODS

Immunohistochemistry was used to analyse GalNAc-T6 and -T3 expressions in 70 clinicopathologically characterised pancreatic cancer cases.

RESULTS

Positive expressions of GalNAc-T6 and -T3 were immunohistochemically identified in 51% (36 of 70) and in 77% (54 of 70) of patients, respectively. A close relationship was noted between GalNAc-T6 positive expression and pathological well/moderate differentiated type (P=0.001), small tumour size (P=0.044), absence of vascular invasion (P=0.009), and low stage of the American Joint Committee on Cancer systems (P=0.043). The expression of GalNAc-T3 significantly correlated with good differentiation (P=0.001), but not with other clinicopathologic features. Furthermore, univariate and multivariate analyses revealed that GalNAc-T6 expression was an independent prognosis indicator for the disease, whereas GalNAc-T3 expression had no impact on clinical outcome, even though 33 of 36 GalNAc-T6-positive cases also had a positive expression of GalNAc-T3 (P=0.001, r=0.356).

CONCLUSION

Both GalNAc-T6 and -T3 expressions correlated significantly with tumour differentiation, whereas only GalNAc-T6 expression predicted prognosis in pancreatic cancer.

Papillary carcinoma in a thyroglossal duct remnant. Three case reports and discussion on management

OBJECTIVE

To report three cases of papillary thyroglossal duct carcinoma (TDCa), and to discuss the diagnostic and therapeutic methods.

CASE REPORTS

We studied the clinical, pathological findings of the tumor, treatment and outcome data on 3 patients treated at our Institution for a papillary TDCa carcinoma and we compared the results with the published cases. Preoperative Fine Needle Aspiration (FNA) and intraoperative frozen section exam was performed in patients 1 and 2. Following the Sistrunk operation (SO), limited thyroidectomy were performed on patients 1 and 2, due to benign lesion. Neck dissections were performed on patients 2 and 3 (second operation after initial SO in other Institute), due to regional lymphadenopathy. The diagnosis of papillary TDCa was confirmed in all cases. Lymph nodes metastases were identified in patients 2 and 3. All patients were treated with levothyroxine therapy. After a median follow-up of 59 months, all patients are alive without recurrence.

CONCLUSIONS

Papillary TDCa is a rare malignancy with excellent prognosis. FNA and intraoperative frozen section exam are the most useful methods for confirmatory diagnosis. Resection of the thyroglossal duct carcinoma by the Sistrunk operation is an adequate surgical approach. Further thyroidectomy should be limited to one either lobe or pyramidal lobe in high risk patients. Total thyroidectomy is recommended only when there is clinical evidence of multifocal malignancy in thyroid gland. Postoperative hormone suppression is advocated.

Exercise improved rat metabolism by raising PPAR-α

Based on the importance of exercise and crucial role of liver in metabolism, the aim of this study was to determine whether the expression of peroxisome proliferator-activated receptor (PPAR)-α, γ and adiponectin receptor 2 in OLETF rat liver were altered in conjunction with improved metabolism with exercise training. OLETF rats were randomly assigned to 2 groups: sedentary control group (n=26), and long-term exercise-trained group (n=26). Full data were available on 32 OLETF rats (16 for each group). Adiponectin, glucose, insulin, triglyceride and cholesterol were assessed. Livers were taken to determine the expression of PPAR-α, γ and adiponectin receptor 2. Compared with sedentary control group, fasting glucose (9.38 ± 2.99 mmol/L vs. 7.32 ± 1.76 mmol/L, P<0.05), triglyceride (1.73 ± 0.34 mmol/L vs. 0.89 ± 0.12 mmol/L, P<0.05) and cholesterol (4.41 ± 0.75 mmol/L vs. 2.13 ± 0.32 mmol/L, P<0.05) were substantially reduced after exercise, which significantly correlated with increased PPAR-α (P<0.05) in liver. The expression of PPAR-α upstream and target genes, including hepatocyte nuclear factor-4 (HNF4), carnitine palmitoyl transferase 1 (CPT-1), catalase (CAT) and ATPbinding cassette transporter A1 (ABCA1) also increased significantly. Therefore, our findings suggest that increased PPAR-α expression in OLETF rats liver is a contributory factor to the exercise-related improvements in whole-body metabolism.