Bronchogenic carcinoma: a survey of CT protocols for staging disease

RATIONALE AND OBJECTIVES

To determine whether a standard computed tomographic (CT) protocol is used in the staging of lung cancer.

MATERIALS AND METHODS

A questionnaire was designed to determine what type of CT scanner is used, whether intravenous contrast material is used, how often the abdomen is scanned and at what level, and the section thicknesses used in scanning the chest and abdomen in patients with lung cancer. A total of 1,118 survey forms were mailed to members of the Society of Thoracic Radiology and to all community hospitals in the United States with at least 300 beds.

RESULTS

The authors received 520 responses (47%) to the 1,118 questionnaires mailed. Of these 520 responses, 140 were from society members, 256 were from hospitals with 300-500 beds, and 124 were from hospitals with more than 500 beds. One-half of hospital respondents used helical CT scanners. Significantly more society members used helical CT scanners (P < .001). Intravenous contrast material was used to opacify mediastinal blood vessels at 449 (86%) of 520 hospitals. Intravenous contrast material was used for liver scanning at 363 (82%) of 444 hospitals, but it was used less often at hospitals in the northeast region and by society members than at hospitals in other regions (P < .001). A mixture of section thicknesses was commonly used (252 [48%] of 520 responses) for scanning the chest; a thickness of 8-10 mm was used in scanning the abdomen at most hospitals (348 [78%] of 445 responses).

CONCLUSION

No CT protocol is consistently used for the examination of patients with lung cancer. Use of intravenous contrast material during chest or liver CT also is not uniform.

Fatal lactic acidosis associated with highly active antiretroviral therapy in patients with advanced human immunodeficiency virus infection in Taiwan

Lactic acidosis (LA), a rare but life-threatening adverse effect associated with antiretroviral therapy, has been reported with an increasing frequency since the mid1990s. From June 1994 to June 2002, a total of six patients, four males and two females with a median age of 43 years (range, 30 to 74 years), had been diagnosed with LA. The estimated incidence of LA was 5.1 per 1000 patient-years (PYs) on highly active antiretroviral therapy (HAART) (95% confidence interval [95% CI], 4.5-5.5 per 1000 PYs) and 4.4 per 1000 PY on nucleoside analogues (NAs) (95% CI, 3.9-4.7 per 1000 PYs). Their median body mass index at diagnosis of LA was 17.6 kg/m2 (range 16.3 to 22.6 kg/m2). The median CD4+ lymphocyte count at the initial diagnosis of HIV infection and at the onset of LA was 38 cells/µL (range, 4 to 103 cells/µL) and 108 cells/µL (range, 79 to 224 cells/µL), respectively. The most common symptoms were nausea, vomiting, and dyspnoea. All of the patients had findings suggestive of NA-related mitochondrial toxicity, such as myositis, pancreatitis, fatty hepatitis, peripheral neuropathy or lipodystrophy. The prescribed NA related to LA were stavudine in six patients, lamivudine, five, and didanosine, one. Despite treatment, all patients died of persistent circulatory collapse following LA. The median duration from diagnosis to death was eight days (range, 4-17 days). Our report highlights that clinicians caring for patients with AIDS should be alerted to the potentially fatal LA associated with antiretroviral therapy when patients present with low body mass index, lipodystrophy, unexplained abdominal symptoms, dyspnoea, or elevated aminotransferases.

Intraluminal renal metastasis from colon cancer simulating a fungus ball

Reports of renal metastasis from colon cancer are unusual, and none have described intraluminal renal metastasis. We describe a patient with a radiolucent filling defect in the renal pelvis that was discovered by percutaneous nephrostomy during prophylactic nephrostomy tube change. Imaging and laboratory results indicated a fungus ball, but pathologic diagnosis of the percutaneously extracted mass was metastatic colonic adenocarcinoma.

Efficacy of hysterosalpingography in evaluating endometriosis

Endometriosis is a common disease in young women being evaluated for infertility. Although endometriosis may cause tubal abnormalities on hysterosalpingography, efficacy of radiographic evaluation in this disease is not clear. We reviewed the radiographic and laparoscopic examinations in 50 women being studied for infertility. Laparoscopy was normal in 15 women and showed endometriosis in 35 patients. Endometriosis was staged at laparoscopy using the classification of the American Fertility Society. Radiographic examinations were reviewed blindly and tubal status noted in each patient. Criteria for tubal abnormality included incomplete or absent filling and ampullary dilatation or convolution. Radiographic efficacy was determined by correlating the tubal appearance to the severity and location of endometriosis. A total of 98 tubes were correlated but only 10 (10%) were felt to be involved by endometriosis based on laparoscopic findings. Radiologic sensitivity was 40% (4 of 10) and specificity was 83% (73 of 88). Positive predictive value was 21% (4 of 19) due to 15 false-positive diagnoses in tubes uninvolved by endometriosis. In conclusion, endometriosis, regardless of its severity, rarely causes radiographic abnormalities on hysterosalpingography because of the location of disease in the pelvis.

Increase in B19 viral load prior to relapse of anaemia in an AIDS patient with persistent B19 infection

Anaemia caused by persistent parvovirus B19 infection can be remitted by intravenous immunoglobulin (IVIG) treatment. However, maintenance IVIG therapy is required in some AIDS patients as well as patients with combined immuno-deficiency because of relapse of anaemia. We used a simple semi-quantitative polymerase chain reaction (PCR) method to trace plasma B19 viral load after administration of IVIG. We noted that the rebound of B19 viral load occurred 6 weeks prior to detection of anaemia. This method may be helpful in determining the interval of maintenance IVIG therapy.

In vivo uptake of ethanol and release of acetate in rat liver and GI

The concentration gradients of ethanol and acetate across liver and GI were determined in overnight starved rats infused with ethanol at a rate (15 mu mol/min/rat) below and a rate (30 mu mol/min/rat) exceeding the rate of ethanol disposal in the animals. Plasma concentrations of ethanol in the systemic circulation reached steady-state levels of approximately 0.6 mM between 30 and 60 min during low rate of infusion; increased steadily from 3.5 mM at 30 min to 6.4 mM at 2 h during high rate of infusion. GI metabolism was determined by concentration differences in aorta and portal vein; hepatic metabolism by differences in hepatic influx and hepatic veins. Hepatic influx was the sum of the concentrations in aorta and portal vein, each multiplied by their fractional contributions to hepatic blood supply. At low rate of infusion, hepatic extraction of ethanol was nearly complete and could be accounted for entirely by the acetate released from liver. The concentrations of ethanol in aorta were greater but not significantly than that in portal vein. At high rate of infusion, hepatic and GI gradients of ethanol remained constant despite changes in circulating concentrations of ethanol. The concentration gradients of ethanol and acetate across liver, though different in signs, were identical in magnitude. GI gradient indicating uptake of ethanol was statistically significant and was about 30% of hepatic gradient. Enzyme activity of alcohol dehydrogenase in stomach was found to be about 10% of that in liver. Our results thus show that acetate generated during ethanol oxidation is completely released from liver in rats, in either conscious or anesthetized state under submaximal or maximal condition of ethanol disposal, and that GI metabolism of circulating ethanol can be as high as one third of the metabolism in liver.

Incidence of post-transfusion hepatitis in Taiwan before and after introduction of anti-HCV testing

The effectiveness of second-generation anti-hepatitis C virus antibody (anti-HCV) screening of blood donations for the prevention of non-A, non-B post-transfusion hepatitis (NANB PTH) was assessed. A prospective study of 192 transfusion recipients was performed to compare the incidence of NANB PTH after the introduction of the second-generation anti-HCV test with the incidence before its introduction. We used a polymerase chain reaction to detect HCV-RNA and HBV-DNA in the sera of patients with NANB PTH. The incidence of acute post-transfusion hepatitis C was 11% (8 of 71) before the screening for anti-HCV as compared with 2.5% (3 of 121) after the screening (p < 0.05). Viremia was detected within the first five weeks of infection in 10 patients with acute post-transfusion hepatitis C. However, there was no significant difference in the incidence of non-A, non-B, non-C (NANBNC) PTH before screening (3 of 71, 4.2%) compared with after screening (3 of 121, 2.5%). Usually, NANBNC PTH was not clinically important. Anti-HCV screening of blood donors significantly reduces the incidence of post-transfusion hepatitis C, but not the incidence of NANBNC PTH.

Film analysis of activated sludge microbial discs by the Taguchi method and grey relational analysis

A biofilm model with substrate inhibition is proposed for the activated sludge growing discs of rotating biological contactor (RBC); this model is different from the steady-state biofilm model based on the Monod assumption. Both deep and shallow types of biofilms are examined and discussed. The biofilm models based on both Monod and substrate inhibition (Haldane) assumptions are compared. In addition, the relationships between substrate utilization rate, biofilm thickness, and liquid phase substrate concentration are discussed. The influence order of the factors that affect the biofilm thickness is studied and discussed by combining the Taguchi method and grey relational analysis. In this work, a Taguchi orthogonal table is used to construct the series that is needed for grey relational analysis to determine the influence priority of the four parameters S(B), kX(f), K(s), and K(i).

HIV-testing of men who have sex with men: variable testing rates among clinicians

High HIV testing coverage of high-risk populations is required to reduce the number of HIV-infected individuals unaware of their status. The aim of this study was to determine HIV testing rates among men who have sex with men (MSM) attending a sexual health service, including the impact of the treating clinician on HIV testing rates. Factors associated with HIV testing of MSM attending the Melbourne Sexual Health Centre for the first time between 2003 and 2009 were determined, including testing rates for individual treating clinicians. Overall, 78% of 4425 men were tested for HIV. Clinician HIV testing rates were higher among nurses (median 89%; range 77–95%) than doctors (median 73%; range 45–88%) with significant differences between individual physicians ( P < 0.001). Lower testing among doctors was independent of reported sexual risk and time since the last HIV test. Substantial differences in HIV testing rates between clinicians were evident with low testing by some. Increasing HIV testing rates among high-risk groups require engagement not only of individuals at risk but also awareness among health-care providers who perform HIV testing.

Hysterosalpingography after hysteroscopic surgery

We reviewed pre- and postoperative appearances of the uterine cavity on hysterosalpingography (HSG) in 28 patients who had hysteroscopic surgery. Twelve patients presented with primary infertility and 16 patients with secondary infertility. The uterine abnormalities included synechiae (12), septa (8), submucosal fibroids (7), and polyp (1). The size and number of lesions in the uterus, the extent of improvement after surgery, and the postoperative pregnancy rate were recorded. The uterine cavity was restored to a normal appearance in 23 (82%) of 28 patients. In patients after fibroid resection, all uterine cavities reverted to normal after surgery. Two patients developed adhesions after septal resection. Three patients with lysis of synechiae remained unchanged or had worsened intrauterine scarring. The postoperative pregnancy rate was 35% (six of 17) in those patients followed for more than 6 months. One patient had a spontaneous abortion. In the six patients who became pregnant, four had secondary infertility, and all had normal or substantial improvement in the appearance of the uterine cavity after surgery. Perforation of the uterus occurred in one patient after resection of a fibroid.

Cost-effective poster and print production with digital camera and computer technology

OBJECTIVE

The purpose of this report is to describe a cost-effective method for producing black-and-white prints and color posters within a radiology department.

CONCLUSION

Using a high-resolution digital camera, personal computer, and color printer, the average cost of a 5 x 7 inch (12.5 x 17.5 cm) black-and-white print may be reduced from $8.50 to $1 each in our institution. The average cost for a color print (8.5 x 14 inch [21.3 x 35 cm]) varies from $2 to $3 per sheet depending on the selection of ribbons for a color-capable laser printer and the paper used. For a 30-panel, 4 x 8 foot (1.2 x 2.4 m) standard-sized poster, the cost for materials and construction is approximately $100.

Comparison of patient reactions and diagnostic quality for hysterosalpingography using ionic and nonionic contrast media

RATIONALE AND OBJECTIVES

We compared adverse reactions and image quality for hysterosalpingography (HSG) performed with ionic (diatrizoate meglumine combined with iodipamide meglumine [DM + IM]) and nonionic (iohexol) contrast media.

METHODS

We performed a study of 95 patients who had HSG and were randomly selected to receive DM + IM or iohexol. Patients reported episodes of abdominal pain and other adverse reactions immediately and 24 hr after the procedure and categorized severity of symptoms on a subjective scale. Two radiologists evaluated image quality for diagnosis.

RESULTS

Prevalence of abdominal pain and other reactions both immediately and 24 hr after HSG was lower in patients who received iohexol than in patients who received DM + IM. Moderate or severe abdominal pain was significantly lower in the iohexol group than in the DM + IM group (p < .05). Visualization of the uterine cavity and ampullary rugae was judged excellent with both contrast media (87% with iohexol and 92% with DM + IM).

CONCLUSION

Iohexol and DM + IM are excellent contrast media for use during HSG; iohexol 300 may cause fewer episodes of more severe and prolonged abdominal pain.

Correlation of lower esophageal mucosal ring and lower esophageal sphincter pressure

We assessed the relationship of lower esophageal sphincter pressure (LESP) to presence and absence of lower esophageal mucosal ring (LEMR) in 66 patients to determine if the LEMR was more likely related to prolonged sphincter hypotension. This potential relationship is of interest because LEMR may be due to reflux esophagitis. Each patient had radiographic and manometric studies, and both examinations were done within one week of each other. The mean LESP in patients with LEMR was 23.8 mm Hg (range 4.2-64 mm Hg) compared to 28.7 mm Hg (range 8-59 mm Hg) in patients without LEMR; the difference was not statistically significant. Patients with LEMR were also divided into three subgroups according to the diameter of the rings (< or = 13 mm, 14-19 mm, > or = 20 mm). There was no significant relationship between the caliber of LEMR and LESP (P > 0.05). Presence of LEMR did not affect the amplitude or duration of primary esophageal peristalsis. These results do not support a relationship between LEMR and prolonged LESP hypotension or abnormal esophageal motility. However, other pathogenetic mechanisms involved in producing reflux esophagitis not related to prolonged sphincter hypotension were not studied.

Genetic variation at nine STR loci in populations from the Philippines and Thailand living in Taiwan

In order to apply a set of nine STR loci and the amelogenin locus in forensic testing, we have performed a population study on individuals from the Philippines and Thailand living in Taiwan (273 Philippine and 146 Thai individuals were typed by commercially available kits and an automated sequencer). A total of 73 alleles for all systems for both populations could be observed in these two populations. No new intermediate fragments were found. Allele frequencies showed no deviation from Hardy-Weinberg equilibrium. The mean exclusion power (MEP) ranged from 0.327 (TPOX) to 0.706 (FGA), the discriminating power (DP) ranged from 0.790 (TPOX) to 0.963 (FGA) for Philippinos, MEP ranged from 0.247 (TPOX) to 0.723 (FGA), DP ranged from 0.761 (TPOX) to 0.968 (FGA) for Thais, the combined MEP is > 0.9988 and the combined DP is > 0.9999999993 for both Philippinos and Thais.

Multiple variants in 5q31.1 are associated with systemic lupus erythematosus susceptibility and subphenotypes in the Han Chinese population

BACKGROUND

A previous study provided evidence for a genetic association between PPP2CA on 5q31.1 and systemic lupus erythematosus (SLE) across multi-ancestral cohorts, but failed to find significant evidence for an association in the Han Chinese population.

OBJECTIVES

To explore the association between this locus and SLE using data from our previously published genome-wide association study (GWAS).

METHODS

Single-nucleotide polymorphisms (SNPs) rs7726414 and rs244689 (near TCF7 and PPP2CA in 5q31.1) were selected as candidate independent associations from a large-scale study in a Han Chinese population consisting of 1047 cases and 1205 controls. Subsequently, 3509 cases and 8246 controls were genotyped in two further replication studies. We then investigated the SNPs' associations with SLE subphenotypes and gene expression in peripheral blood mononuclear cells.

RESULTS

Highly significant associations with SLE in the Han Chinese population were detected for SNPs rs7726414 and rs244689 by combining the genotype data from our previous GWAS and two independent replication cohorts. Further conditional analyses indicated that these two SNPs contribute to disease susceptibility independently. A significant association with SLE, age at diagnosis < 20 years, was found for rs7726414 (P = 0·001). The expression levels of TCF7 and PPP2CA messenger RNA in patients with SLE were significantly decreased compared with those in healthy controls.

CONCLUSIONS

This study found evidence for multiple associations with SLE in 5q31.1 at genome-wide levels of significance for the first time in a Han Chinese population, in a combined genotype dataset. These findings suggest that variants in the 5q31.1 locus not only provide novel insights into the genetic architecture of SLE, but also contribute to the complex subphenotypes of SLE.

Vicarious contrast material excretion in patients with acute unilateral ureteral obstruction

Radiographs of 45 patients with evidence of acute unilateral ureteral obstruction at intravenous urography, obtained at least 24 hours after injection of contrast material, were retrospectively studied. Vicarious contrast material excretion (VCME) as evidence by gallbladder opacification on delayed radiographs was seen in 19 patients (42%), 10 of whom also showed extravasation of contrast material. A total of 15 of the 45 patients developed spontaneous extravasation; 10 (67%) showed VCME, while only nine of the 30 patients (30%) who did not have spontaneous extravasation of contrast material showed VCME. The creatinine level was elevated (greater than 1.5 mg/dL [133 mumol/L]) in four patients with VCME and in six patients without. This series indicates that VCME is more common than previously appreciated in patients with acute unilateral ureteral obstruction and occurs with greater frequency when obstruction is associated with contrast material extravasation.

Impact of the small bowel study on patient management

Medical records of 528 consecutive patients who had a peroral small bowel examination or enteroclysis were reviewed. Clinical indications, efficacy of the small bowel examinations, and patient outcome were correlated to determine the impact of the small bowel examination on patient management. The most frequent indications were abdominal pain (19%), diarrhea (15%), obstruction (12%), bleeding (11%), postsurgical evaluation (10%), and assessment of Crohn's disease (8%). Two thirds of the studies (67%) were normal, and 33% of the examinations were abnormal, with similar results in all age groups. Small bowel obstruction (13%), miscellaneous results primarily including diffuse small bowel diseases (7%), adhesions (6%), and Crohn's disease (5%) were the most common abnormalities detected. The effects of small bowel studies on patient management were exclusion of serious pathology (67%), diagnosis that changed therapy (32%), and incidental findings (1%). Small bowel enteroclysis had a higher yield of positive examinations than the peroral small bowel examination, most likely due to patient selection.