Fast spin Echo Magnetic Resonance Imaging: Clinical Application in Screening for Acoustic Neuroma

The advent of magnetic resonance imaging has greatly improved our ability to diagnose acoustic tumors, but it is a relatively expensive imaging modality. In the present climate of medical cost restraints, methods that reduce costs but maintain quality are extremely desirable. We report a new magnetic resonance imaging technique that uses fast spin echo without gadolinium. It provides ultrahigh-resolution images of the internal auditory canal and cerebellopontine angle. The sensitivity of this technique for the detection of acoustic tumors is equivalent to conventional gadolinium-enhanced magnetic resonance imaging, but the global cost is comparable with that of brain stem audiometry. In our practice fast spin echo magnetic resonance imaging has replaced brain stem audiometry as a screening modality to evaluate most acoustic tumor suspects. Also, the intricate detail of the internal auditory canal anatomy provided by this technique is useful in planning surgical removal of acoustic tumors.

Interval mammography after needle localization biopsy of breast abnormalities that are pathologically benign

BACKGROUND

Needle localization biopsy is commonly performed for the diagnosis of mammographic abnormalities. Routine specimen radiography is generally recommended, but the value of routine short-interval postbiopsy mammography has not been analyzed.

PATIENTS AND METHODS

We performed a retrospective review of 299 consecutive localized biopsies in 286 women from March 1989 to November 1993. Of these biopsies, 217 from the basis for this study; all yielded a benign pathologic diagnosis and had both specimen radiography and 3-month interval mammograms performed.

RESULTS

A total of 192 (88%) of postbiopsy mammograms were interpreted as negative, while 22 (10%) were suspicious. Three patients had second biopsies and all had benign diagnoses, 16 had follow-up mammograms that were interpreted as normal or stable, and 3 patients were lost to follow-up. A suspicious postbiopsy mammogram had no significant relationship to initial mammographic abnormality or pathologic diagnosis, but did correlate with specimen radiograph interpretation (P = 0.02) by chi-square comparison).

CONCLUSIONS

In a series of needle localization biopsies with intraoperative specimen radiography, postbiopsy mammography failed to reveal any missed cancers. Short-interval follow-up mammography is unnecessary to assess for residual abnormalities when specimen radiography confirms excision of the abnormality.

Murine embryonic yolk sac cells promote in vitro proliferation of bone marrow high proliferative potential colony-forming cells

To examine the influence of the hematopoietic microenvironment on hematopoietic cell proliferation and differentiation during the yolk sac phase of hematopoiesis, we have recently established cell lines from embryonic yolk sac visceral endoderm (YSE) and mesoderm (YSM). In the present experiments, we compared in vitro growth of adult murine bone marrow high proliferative potential colony-forming cells (HPP-CFC) in coculture with YSE- and YSM-derived or adult bone marrow stromal cell lines. Whereas both yolk sac-derived and adult stromal cell lines supported the proliferation of HPP-CFC during coculture, YSE- and YSM-derived cells stimulated a significant increase in total HPP-CFC compared with adult bone marrow stromal cell lines. Conditioned media from both YSE- and YSM-derived cell lines also stimulated the growth of HPP-CFC in vitro, but only in combination with exogenous recombinant hematopoietic growth factors. Although multiple hematopoietic growth factor mRNAs were detected in the yolk sac-derived cells by polymerase chain reaction, only macrophage colony-stimulating factor (M-CSF) activity was detected in conditioned media using an enzyme-linked immunosorbent assay. A neutralizing polyclonal antibody against M-CSF did not diminish the YSE- or YSM-derived cell line conditioned media promotion of HPP-CFC colony formation. These results suggest that murine yolk sac-derived cell lines produce a novel soluble factor(s) that recruits primitive bone marrow hematopoietic cells to grow in vitro in response to a combination of hematopoietic growth factors.

Origins of childhood dental fear

This study explored Rachman's theory of fear acquisition applied to fear of the dentist in a large sample of low income American primary school children. Children and their mother/guardians were interviewed or completed questionnaires in the home about fear acquisition and related concerns. A multivariate logistic regression model was evaluated in order to explore the relationship of direct conditioning and modeling variables to fear levels. Both direct conditioning and parent modeling factors were significant independent predictors of fear level even when controlling for gender, age and other sociodemographic and attitudinal factors.

Dementia in acute units: agitation

Despite the prevalence of disturbed behaviour in people with dementia, little research has gone into understanding such behaviour and managing it effectively. This article, the penultimate in the series, examines the causes and management of restlessness and agitation in people with dementia, and proposes a holistic approach.

Reproducibility and observer variability of transrectal ultrasound measurements of prostatic volume

Transrectal ultrasound (TRUS) is an established investigation in benign and malignant prostatic disease though the level of reproducibility of TRUS volume measurements is not known. A group of observers in the UK and the USA who were participating in linked prospective studies of benign prostatic hyperplasia each carried out measurements during real-time scanning and on a series of static TRUS images. Results demonstrated good reproducibility for measurements of antero-posterior, transverse, and longitudinal dimensions of the prostate by an experienced UK urologist; only a minor degree of interobserver variation occurred in measurements made between experienced UK and USA observers. Using static images, USA observers obtained results that were in good agreement, whereas the UK observers, only two of whom used TRUS regularly, were in poor agreement with each other. This study demonstrates a high level of reproducibility for TRUS volume measurements performed by experienced observers.

Techniques for understanding the customer

Who are the customers and what do they want? Every health care employee sometimes serves as a supplier providing input to an activity and sometimes as the recipient of the activity. This article explains the Kano model, which distinguishes between expected quality, one-dimensional, quality, and exciting quality. It also introduces Quality Function Deployment and the Customer Window, two tools for understanding and prioritizing customer demands.

Bovine pulmonary blastomas: histomorphologic description and immunohistochemistry

Three adult female dairy cattle with pulmonary blastomas were evaluated. The gross lesions at postmortem were described as multiple white circumscribed masses throughout the lungs, with pleural involvement in one cow and lymph node metastasis in the other two cows. Histologically, the tumors contained a dual population of mesenchymal and epithelial neoplastic cells. Epithelial cells formed nests, tubules, and formations resembling bronchioles of normal lung. Mesenchymal cells were spindle shaped with oval nuclei and fibrillar eosinophilic cytoplasm, were large rounded cells with multiple round nuclei and granular eosinophilic cytoplasm, or appeared blast-like, with large hyperchromatic nuclei and amphophilic cytoplasm. The tumors varied greatly in appearance from one field to another within the same tumor. Epithelial cells stained positively with anticytokeratin antibodies. Some spindle-shaped mesenchymal cells exhibited smooth muscle cell differentiation with positive staining with anti-vimentin, anti-muscle-specific actin, and anti-smooth muscle actin antibodies, whereas other rounded mesenchymal cells expressed striated muscle cell differentiation with multiple nuclei and positivity to anti-neuron-specific enolase and anti-muscle-specific actin antibodies. The variable expression of the intermediate filaments and cytoplasmic enzymes indicates multiple pathways of differentiation in the pulmonary blastomas.

The effect of directly observed therapy on the rates of drug resistance and relapse in tuberculosis

BACKGROUND

Tuberculosis has reemerged as an important public health problem, and the frequency of drug resistance is increasing. A major reason for the development of resistant infections and relapse is poor compliance with medical regimens. In Tarrant County, Texas, we initiated a program of universal directly observed treatment for tuberculosis. We report the effect of the program on the rates of primary and acquired drug resistance and relapse among patients with tuberculosis.

METHODS

We collected information on all patients with positive cultures for Mycobacterium tuberculosis in Tarrant County from January 1, 1980, through December 31, 1992. Through October 1986, patients received a traditional, unsupervised drug regimen. Beginning in November 1986, nearly all patients received therapy under direct observation by health care personnel.

RESULTS

A total of 407 episodes in which patients received traditional treatment for tuberculosis (January 1980 through October 1986) were compared with 581 episodes in which therapy was directly observed (November 1986 through December 1992). Despite higher rates of intravenous drug use and homelessness and an increasing rate of tuberculosis during this 13-year period, the frequency of primary drug resistance decreased from 13.0 percent to 6.7 percent (P < 0.001) after the institution of direct observation of therapy, and the frequency of acquired resistance declined from 14.0 percent to 2.1 percent (P < 0.001). The relapse rate decreased from 20.9 percent to 5.5 percent (P < 0.001), and the number of relapses with multidrug-resistant organisms decreased from 25 to 5 (P < 0.001).

CONCLUSIONS

The administration of therapy for M. tuberculosis infection under direct observation leads to significant reductions in the frequency of primary drug resistance, acquired drug resistance, and relapse.