Long-Term Efficacy of T3 Analogue Triac in Children and Adults With MCT8 Deficiency: A Real-Life Retrospective Cohort Study

CONTEXT

Patients with mutations in thyroid hormone transporter MCT8 have developmental delay and chronic thyrotoxicosis associated with being underweight and having cardiovascular dysfunction.

OBJECTIVE

Our previous trial showed improvement of key clinical and biochemical features during 1-year treatment with the T3 analogue Triac, but long-term follow-up data are needed.

METHODS

In this real-life retrospective cohort study, we investigated the efficacy of Triac in MCT8-deficient patients in 33 sites. The primary endpoint was change in serum T3 concentrations from baseline to last available measurement. Secondary endpoints were changes in other thyroid parameters, anthropometric parameters, heart rate, and biochemical markers of thyroid hormone action.

RESULTS

From October 15, 2014 to January 1, 2021, 67 patients (median baseline age 4.6 years; range, 0.5-66) were treated up to 6 years (median 2.2 years; range, 0.2-6.2). Mean T3 concentrations decreased from 4.58 (SD 1.11) to 1.66 (0.69) nmol/L (mean decrease 2.92 nmol/L; 95% CI, 2.61-3.23; P < 0.0001; target 1.4-2.5 nmol/L). Body-weight-for-age exceeded that of untreated historical controls (mean difference 0.72 SD; 95% CI, 0.36-1.09; P = 0.0002). Heart-rate-for-age decreased (mean difference 0.64 SD; 95% CI, 0.29-0.98; P = 0.0005). SHBG concentrations decreased from 245 (99) to 209 (92) nmol/L (mean decrease 36 nmol/L; 95% CI, 16-57; P = 0.0008). Mean creatinine concentrations increased from 32 (11) to 39 (13) µmol/L (mean increase 7 µmol/L; 95% CI, 6-9; P < 0.0001). Mean creatine kinase concentrations did not significantly change. No drug-related severe adverse events were reported.

CONCLUSIONS

Key features were sustainably alleviated in patients with MCT8 deficiency across all ages, highlighting the real-life potential of Triac for MCT8 deficiency.

Experiences of United States genetic counseling supervisors regarding race/ethnicity in supervision: A qualitative investigation

While addressing culture in supervision is important, research suggests genetic counseling supervisors are unsure how to discuss it within the supervisory relationship. This study explored the perceptions of genetic counselor supervisors from the United States regarding how their supervisors approached racial/ethnic differences in their supervisory relationships when they were students, effects on those relationships, and subsequent influences on their supervision practices. Nine genetic counselors who self-identified as White/Caucasian, and nine who self-identified as racial/ethnic backgrounds other than White/Caucasian, were purposively recruited to participate in semi-structured phone interviews. Questions explored participant perceptions of how their supervisors approached racial/ethnic differences in supervision, effects on those supervisory relationships, and influences of their experiences as students on their current supervision practice. Thematic analysis revealed four major themes, with most participants agreeing that (1) recognition of race/ethnicity in supervision was limited as a student and in their current supervision practices; (2) supervisors vary in their comfort discussing race/ethnicity; (3) prior student supervision experiences of racial/ethnic differences have limited effects on current supervision practice; and (4) supervisors desire more training in how to approach conversations around race/ethnicity. Further professional discussions about the role of race/ethnicity in the supervisory relationship and training in addressing the cultural context in supervision are needed.

Rehabilitation Teachers and Orientation & Mobility Instructors: Interprofessional Perceptions

This article reports the findings of a nationwide survey of rehabilitation teachers and orientation and mobility instructors, designed to identify their interprofessional perceptions. The Interprofessional Perceptions Scale (IPS) was used to determine perceptions relating to the general areas of mutual respect, relative roles, professional competence, and professional status. Subjects in each group reported a generally positive attitude toward the other group of professionals. However, issues relating to professional role and professional status appear to cause some difficulty between the groups. Suggestions for increasing teamwork efficiency are presented.

Medical infrared thermal imaging of syringomyelia in the Cavalier King Charles Spaniel

Background

Medical infrared thermal imaging (MITI) is a non-invasive imaging modality gaining popularity in the veterinary field. An infrared camera captures emission of heat and creates a color map in the form of a thermogram. Topical heat emission is influenced by localized disease processes as a result of autonomic nervous system imbalance. The purpose of this study was to determine the utility of using thermography to identify changes in thermographic patterns associated with syringomyelia (SM) presence or absence in Cavalier King Charles Spaniels (CKCS) with Chiari-like Malformation (CLM).

Results

In CKCS with CLM, MITI was most accurate at a texture distance of 6. Optimizing imaging feature sets produced a highest accuracy of 69.9% (95% CI: 59.5–79.0%), with 81.3% sensitivity and 57.8% specificity for identifying the presence of syringomyelia.

Conclusion

Thermographic image analysis is a successful non-invasive, diagnostic test that can be used to screen for syringomyelia presence in a CKCS with CLM.

Medical infrared thermal imaging of canine appendicular bone neoplasia

Background

Medical infrared thermal imaging (MITI) is a noninvasive imaging modality used in veterinary medicine as a screening tool for musculoskeletal and neurological disease processes. An infrared camera measures the surface body heat and produces a color map that represents the heat distribution. Local trauma or disease can impair the autonomic nervous system, which leads to changes in the local dermal microcirculation and subsequent alteration of surface body heat. Disruption of autonomic flow to the cutaneous vasculature at deeper levels can also result in asymmetric thermographic results. The purpose of this study was to evaluate surface temperature differences between limbs affected by bone neoplasia and their normal contralateral limbs.

Results

A statistically significant difference in average temperature was noted between regions of interest of the two groups (paired difference: 0.53 C° ± 0.14; P = 0.0005). In addition, pattern recognition analysis yielded a 75–100% success rate in lesion identification.

Conclusions

Significant alterations noted with average temperature and thermographic patterns indicate that MITI can document discernible changes associated with the presence of canine appendicular bone tumors. While MITI cannot be used as the sole diagnostic tool for bone cancer, it can be used as a screening modality and may be applicable in early detection of cancer.

Association Between PRRSV ORF5 Genetic Distance and Differences in Space, Time, Ownership and Animal Sources Among Commercial Pig Herds

The objective of this study was to investigate associations between genetic distance of porcine reproductive and respiratory syndrome virus (PRRSV) detected in Ontario swine herds, and the distance between the herds with respect to space, time, ownership and animal sources. PRRSV sequence data between September 2004 and August 2007 were obtained from the Animal Health Laboratory of the University of Guelph. Geographical coordinates were obtained from the Ontario Pork marketing board, and network information about ownership and animal suppliers was obtained using a telephone interview. The matrices of sequence, spatial, temporal and network distances were generated and were analysed using the Mantel test, and using linear-mixed models with P-values based on random permutations. A total of 438 PRRSV isolates from 329 premises and 232 ownerships were originally included; 57 of the isolates were considered vaccine type. The Mantel correlation test indicated that there was positive correlation between sequence distance and geographic distance (r = 0.11, P = 0.001), as well as sequence distance and temporal distance (r = 0.03, P = 0.03), with similar results reported after adjusting for the ownership distance. Mantel correlogram suggested existence of spatial correlation up to ~30 km distance. Multivariable linear-mixed model for association between genetic distance and space-time distance was characterized by the three-way interaction among space, time and ownership (P < 0.001). It suggested that positive association between sequence similarity and spatial proximity exists in herds under different ownerships, but its magnitude is very small. In contrast, for pairs of herds under identical ownership, the spatial association was more complex. This could be a consequence of interactions within ownerships, or alternatively decisions made about sampling of herds for diagnostic purposes. Of the networks evaluated, ownership (P < 0.001) and gilt supplier (P < 0.001) showed the highest magnitude of association with genetic distance and should be investigated further for their impact on disease spread.

Biomarkers in the assessment of acute and chronic kidney diseases in the dog and cat

In both human and veterinary medicine, diagnosing and staging renal disease can be difficult. Measurement of glomerular filtration rate is considered the gold standard for assessing renal function but methods for its assessment can be technically challenging and impractical. The main parameters used to diagnose acute and chronic kidney disease include circulating creatinine and urea concentrations, and urine-specific gravity. However, these parameters can be insensitive. Therefore, there is a need for better methods to diagnose and monitor patients with renal disease. The use of renal biomarkers is increasing in human and veterinary medicine for the diagnosis and monitoring of acute and chronic kidney diseases. An ideal biomarker would identify site and severity of injury, and correlate with renal function, among other qualities. This article will review the advantages and limitations of renal biomarkers that have been used in dogs and cats, as well as some markers used in humans that may be adapted for veterinary use. In the future, measuring a combination of biomarkers will likely be a useful approach in the diagnosis of kidney disorders.

Low central venous oxygen saturation is associated with increased mortality in critically ill dogs

OBJECTIVES

To investigate relationships between central venous oxygen saturation (ScvO(2)) and survival to hospital discharge in dogs. Central venous oxygen saturation is an accessible measure of the balance between systemic oxygen delivery and consumption.

METHODS

Prospective observational cohort study, enrolling 126 client-owned dogs with central venous catheters. Central venous oxygen saturation was measured over the 24 hours following intensive care unit admission. Poor outcome was defined as death or euthanasia performed for moribund status. Regression analysis identified independent predictors of non-survival and physiologic parameters associated with central venous oxygen saturation. Area under the receiver operator curve analysis identified a cut-off point of central venous oxygen saturation, below which central venous oxygen saturation decrease was associated with increased mortality risk.

RESULTS

Mortality risk was 30·9%. Low central venous oxygen saturation was associated with poor outcome (P<0·05). Area under the receiver operator curve analysis selected a central venous oxygen saturation of 68% as the point below which a fall in central venous oxygen saturation was associated with increased mortality risk. For each 10% drop in central venous oxygen saturation below 68%, odds of non-survival increased by 2·66 times (P=0·0002, 95% confidence interval of odds ratio=1·45 to 4·85). Central venous oxygen saturation was equivalent to lactate in predicting non-survival. Predictors of central venous oxygen saturation (packed cell volume, mean arterial blood pressure, fever, % arterial haemoglobin saturation as measured by pulse oximeter) were consistent with hypothesised physiologic mechanisms.

CLINICAL SIGNIFICANCE

Central venous oxygen saturation was a strong mortality predictor. Further work is needed to determine if therapy targeting central venous oxygen saturation can reduce mortality in canine intensive care unit patients.

The Feline Acute Patient Physiologic and Laboratory Evaluation (Feline APPLE) Score: a severity of illness stratification system for hospitalized cats

BACKGROUND

Scores allowing objective stratification of illness severity are available for dogs and horses, but not cats. Validated illness severity scores facilitate the risk-adjusted analysis of results in clinical research, and also have applications in triage and therapeutic protocols.

OBJECTIVE

To develop and validate an accurate, user-friendly score to stratify illness severity in hospitalized cats.

ANIMALS

Six hundred cats admitted consecutively to a teaching hospital intensive care unit.

METHODS

This observational cohort study enrolled all cats admitted over a 32-month period. Data on interventional, physiological, and biochemical variables were collected over 24 hours after admission. Patient mortality outcome at hospital discharge was recorded. After random division, 450 cats were used for logistic regression model construction, and data from 150 cats for validation.

RESULTS

Patient mortality was 25.8%. Five- and 8-variable scores were developed. The 8-variable score contained mentation score, temperature, mean arterial pressure (MAP), lactate, PCV, urea, chloride, and body cavity fluid score. Area under the receiver operator characteristic curve (AUROC) on the construction cohort was 0.91 (95% CI, 0.87-0.94), and 0.88 (95% CI, 0.84-0.96) on the validation cohort. The 5-variable score contained mentation score, temperature, MAP, lactate, and PCV. AUROC on the construction cohort was 0.83 (95% CI, 0.79-0.86), and 0.76 (95% CI, 0.72-0.84) on the validation cohort.

CONCLUSIONS AND CLINICAL IMPORTANCE

Two scores are presented enabling allocation of an accurate and user-friendly illness severity measure to hospitalized cats. Scores are calculated from data obtained over the 1st 24 hours after admission, and are diagnosis-independent. The 8-variable score predicts outcome significantly better than does the 5-variable score.

The acute patient physiologic and laboratory evaluation (APPLE) score: a severity of illness stratification system for hospitalized dogs

BACKGROUND

Objective risk stratification models are used routinely in human critical care medicine. Applications include quantitative and objective delineation of illness severity for patients enrolled in clinical research, performance benchmarking, and protocol development for triage and therapeutic management.

OBJECTIVE

To develop an accurate, validated, and user-friendly model to stratify illness severity by mortality risk in hospitalized dogs.

ANIMALS

Eight hundred and ten consecutive intensive care unit (ICU) admissions of dogs at a veterinary teaching hospital.

METHODS

Prospective census cohort study. Data on 55 management, physiological, and biochemical variables were collected within 24 hours of admission. Data were randomly divided, with 598 patient records used for logistic regression model construction and 212 for model validation.

RESULTS

Patient mortality was 18.4%. Ten-variable and 5-variable models were developed to provide both a high-performance model and model maximizing accessibility, while maintaining good performance. The 10-variable model contained creatinine, WBC count, albumin, SpO(2) , total bilirubin, mentation score, respiratory rate, age, lactate, and presence of free fluid in a body cavity. Area under the receiver operator characteristic (AUROC) on the construction data set was 0.93, and on the validation data set was 0.91. The 5-variable model contained glucose, albumin, mentation score, platelet count, and lactate. AUROC on the construction data set was 0.87, and on the validation data set was 0.85.

CONCLUSIONS AND CLINICAL IMPORTANCE

Two models are presented that enable allocation of an accurate and user-friendly illness severity index for dogs admitted to an ICU. These models operate independent of primary diagnosis, and have been independently validated.

Methicillin resistant Staphylococcus aureus colonization in pigs and pig farmers

Methicillin resistant Staphylococcus aureus (MRSA) colonization has recently been identified in pigs and people that work with pigs, raising concerns about the role of pigs as reservoirs of MRSA for human infection. The objectives of this study were to evaluate the prevalence of MRSA colonization in pigs and pig farmers in Ontario, Canada and to characterize MRSA strains. Nasal and rectal swabs were collected from 285 pigs from three different age groups from 20 pig farms. Nasal swabs were collected from farm personnel and a brief questionnaire was also administered. The prevalence of MRSA colonization in farms was 45% (9/20) whereas the prevalence in pigs was 24.9% (71/285). There was no difference in MRSA colonization between age groups. The prevalence of MRSA colonization in pig farmers was 20% (5/25). There was a correlation between the presence of MRSA in pigs and humans on farms (P value=0.001). The results of spa typing revealed the predominant strain in pigs and humans was eGenomics spa type 539 (Ridom t034, clonal complex 398) which accounted for 59.2% of isolates and has been reported in pigs in Europe. A common human epidemic clone, CMRSA-2 (USA100, clonal complex 5) was also found in both pigs and pig personnel. Indistinguishable strains were found in pigs and pig personnel on all five farms with a colonized human. This study demonstrates that MRSA is common in pigs in Ontario, Canada, and provides further support to concerns about transmission of MRSA between pigs and humans.

The effect of feeding fermented liquid whey plus dextrose inoculated with specific lactic acid bacteria of pig origin to weanling pigs challenged with Escherichia coli O149:K91:F4

The objective of this study was to determine the efficacy of using fermented liquid whey inoculated with specific lactic acid bacteria of pig origin to reduce the severity and progression of postweaning enterotoxigenic Escherichia coli diarrhea in weanling pigs challenged with E. coli O149:K91:F4. Based on two trials, it was determined that feeding inoculated fermented whey in a liquid diet did not affect growth performance or the severity or duration of postweaning diarrhea compared with a conventional dry feed containing an antibiotic. Because this study is one of very few examining the use of liquid feed and co-products inoculated with probiotics to control postweaning E. coli diarrhea, more studies are needed to confirm these results.

Novel erythropoiesis stimulating protein for treatment of anemia in chronic renal insufficiency

BACKGROUND

Novel erythropoiesis stimulating protein (NESP) is a glycoprotein with a threefold longer terminal half-life than recombinant human erythropoietin (rHuEPO) in humans. The aim of this study was to determine whether NESP is effective for the treatment of anemia at a reduced dosing frequency relative to rHuEPO in patients with chronic renal failure not yet on dialysis [chronic renal insufficiency (CRI)].

METHODS

This was a multicenter, randomized, open-label study. A total of 166 rHuEPO-naive patients with CRI were randomized in a 3:1 ratio to receive NESP (0.45 microg/kg once weekly) or rHuEPO (50 U/kg twice weekly) administered subcutaneously for up to 24 weeks. Dose adjustments were made as necessary to achieve a hemoglobin response, defined as an increase > or =1.0 g/dL from baseline and a concentration > or = 11.0 g/dL.

RESULTS

During the 24-week treatment period, 93% (95% CI, 87 to 97%) of patients receiving NESP and 92% (95% CI, 78 to 98%) of patients receiving rHuEPO achieved a hemoglobin response. The median time to response was seven weeks (range of 3 to 25 weeks) in both groups. After correction of anemia, mean hemoglobin concentrations were maintained within the target range of 11.0 to 13.0 g/dL for the remainder of the 24-week treatment period. The safety profiles of NESP and rHuEPO were similar, and no antibodies were detected to either drug.

CONCLUSIONS

These results demonstrate that NESP safely and effectively corrects and maintains hemoglobin concentrations at a reduced dosing frequency relative to rHuEPO in patients with CRI, providing a potential benefit to patients and health care providers.

The frequency of otitis media with effusion in British pre-school children: a guide for treatment. ALSPAC Study Team

Data on the prevalence of otitis media with effusion (OME) as shown by serial tympanometry is presented for young children during the first 5 years of life. The children were participants in the Avon Longitudinal Study of Pregnancy and Childhood (ALSPAC); a randomly selected 10% (n = 1400) of whom were selected for examination at ages 8, 12, 18, 25, 31, 37, 43, 49 and 61 months. Whilst sex had no effect, there was a decrease in prevalence of OME with increasing age. There was a marked seasonal effect on the prevalence of OME. Bilateral and unilateral OME were significantly more prevalent in the winter than in the summer months (36.6% in February in children aged 8 months compared with 16% at 61 months and 16.4% in August in children aged 8 months compared with 3.1% at 61 months). The results form an important background against which to assess both the results of screening and also the indications for surgical treatment.

Simple and effective technique of guided biopsy in a closed MRI system

BACKGROUND

Magnetic resonance (MR)-guided biopsies are generally regarded as complex interventions. We implemented interventional MR (IMR) with the resources available in and for practical application in a large (1100 beds) central hospital.

METHODS

This simple and straightforward IMR technique uses a step-by-step approach for localization, access route planning, biopsy, verification in at least two planes, and postoperative control. The technique has been used and evaluated unchanged for more than 400 punctures and interventions.

RESULTS

Contrast, signal, matrix options, and visibility of needle track and tip permit uncomplicated orientation. The mean duration of a biopsy is 19 min. The technique can be applied to all radiologic puncture settings without any technical or medical complications.

CONCLUSION

The crucial step in implementing IMR is not to contemplate its application but to simply start applying the procedure.

The relationship between otitis media with effusion and contact with other children in a british cohort studied from 8 months to 3 1/2 years. The ALSPAC Study Team. Avon Longitudinal Study of Pregnancy and Childhood

OBJECTIVE

It is generally acknowledged that otitis media with effusion is more prevalent among children attending grouped day care. This study aimed to refine this by determining the relationships with the numbers of children at the place of day care, the age of the child and the number of siblings he/she had.

METHODS

ALSPAC (the Avon Longitudinal Study of Pregnancy and Childhood) is a population based longitudinal study starting early in pregnancy and following the children throughout their lives. Nested within this study, a randomly selected group of 1590 children, the Children in Focus, were invited to attend a clinic for hands on examinations. Tympanometry was carried out at ages 8, 12, 18, 25, 31, 37 and 43 months of age. Bilateral otitis media with effusion (OME) was identified if both ears showed a flat trace. Multi-level modelling with logistic regression adjusted for a number of social and environmental influences.

RESULTS

Of the 1590 children invited to the 8-month clinic, 300 (19%) were excluded from the analysis because of failure to attend or because of missing data. The analyses were based on 1290 children. The prevalence of bilateral OME decreased with age, from 24.6% at 8 months to 11.9% at 43 months. Children with older siblings and those attending day care with four or more other children were at an increased risk of OME. The adjusted odds ratios (AOR) were 1.52 (95% confidence interval [CI] = 1.23, 1.88) and 1.36 (95% CI = 1.02, 1.82), respectively. The risk associated with older siblings declined with age and by 3 years these children were no longer more likely to have OME than children with no older siblings. No such interaction with age was found for children in group day care and these children continued to be at an increased risk over the entire age period of the study. There was no increased risk associated with day care when no other children attended (AOR = 1.18, 95% CI = 0.88, 1.58) or when one to three others were present (AOR = 1.10, 95% CI = 0.85, 1.42). Although there was no relationship with the number of hours spent in day care, children who had started attending group care with four or more other children before 9 months of age did have an increased risk compared with children starting later AOR = 1.88, 95% CI = 1.12, 3.14.

CONCLUSIONS

These results provide evidence that early contact with other children increases the risk of OME and that children attending day care with four or more other children remain at an increased risk of OME at least until 31/2 years.

Does the supine sleeping position have any adverse effects on the child? II. Development in the first 18 months. ALSPAC Study Team

OBJECTIVE

To assess whether the recommendations that infants sleep supine could have adverse consequences on their motor and mental development.

DESIGN

A prospective study of infants, delivered before, during, and after the Back to Sleep Campaign in the United Kingdom, followed to 18 months of age.

SUBJECTS

The children were participants of the Avon Longitudinal Study of Pregnancy and Childhood born to mothers resident in the three former Bristol-based health districts of Avon, with expected date of delivery from April 1, 1991 to December 31, 1992. Questionnaires were completed on sleeping position at 4 to 6 weeks of age and sets of standardized questions on development at 6 and 18 months.

MAIN OUTCOME MEASURES

Social, communication, fine and gross motor, and total developmental scales based on the Denver Developmental Screening Test at 6 and 18 months.

RESULTS

After adjustment for 27 factors using multiple regression, 3 of the 10 scales and subscales significantly distinguished between front and back sleeping position. At 6 months of age, infants put to sleep on their front had a mean score 0.38 SD (95% confidence interval [CI]: 0.28, 0.49) higher on the gross motor scale, 0.11 SD (95% CI: 0.00, 0.23) higher in the social skills scale, and a total development score 0.20 SD (95% CI: 0.10, 0.30) higher than those on their backs. These differences were no longer apparent at 18 months.

CONCLUSIONS

There is some evidence that putting infants to sleep in the supine position results in a reduced developmental score at 6 months of age, but this disadvantage appears to be transient. Weighing this against the adverse health effects demonstrated with the prone sleeping position, these results should not change the message of the Back to Sleep Campaign.

Spinal cord swelling as a myelographic indicator of prognosis: a retrospective study in dogs with intervertebral disc disease and loss of deep pain perception

The association of myelographic spinal cord swelling with neurological outcome was examined in 46 dogs with intervertebral disc disease and absence of deep pain perception (DPP). Spinal cord swelling was measured by calculating a ratio of the length of the loss of the myelographic dye column to the length of the second lumbar vertebra (L2). A positive neurological outcome was defined as return of voluntary motor function. A cut-off value for swelling:L2 of 5.0 was established by the creation of a receiver operator characteristic curve. Using a swelling:L2 ratio of 5.0 as a cutoff for indication of neurological recovery yielded a sensitivity of 74% and a specificity of 61%. Overall neurological recovery rate was 43%. Dogs with spinal cord swelling:L2 ratios less than 5.0 had a recovery rate of 61%, whereas dogs with a ratio greater than or equal to 5.0 had a recovery rate of 26%. Evaluation of these data by chi square analysis confirmed that a ratio less than 5.0 was associated with a positive outcome, and a ratio greater than or equal to 5.0 was associated with a negative outcome, (P < .05). Although other factors, such as duration of neurological signs, affect neurological outcome in dogs with no DPP, evaluation of myelographic spinal cord swelling can assist in establishing a prognosis.

[MRT in nonpalpable testes]

Magnetic resonance imaging was performed in 22 male patients for localisation of 27 nonpalpable undescended testes. The operative verification, carried out in 19 testes (15 patients) served as basis for checking on the accuracy of MRI results and for their comparison with those of sonography and laparoscopy. The impalpable testis was localised via MRI in 13 cases and its lack was correctly established in three cases. There were three false MRI diagnoses. The suspicion of two intraabdominal localised testes were not confirmed at surgery and one intracanalicular testes were not seen by MRI. The low signal intensity of the undescended testes on T2-weighted images is indicative for fibrotic changes and may be of value for more accurate planning of the operative volume. MRI offers a new promising opportunity for localisation and morphologic estimation of the undescended testis and should be performed before the invasive investigation methods.

[Dynamic MRT after Gd-DTPA administration in kidney transplants: the susceptibility and T2 effects]

35 kidney transplanted patients (15 without pathological findings and 20 with histologically proven chronic rejection) were investigated with a combination of dynamic MR and bolus application of Gd-DTPA. The occurrence of susceptibility artifacts and T2 effects at the junction between papilla and renal calix were analysed. There are two groups of patients. The first one shows only artifacts due to susceptibility. The second group indicates the so-called "dark ring pattern" (susceptibility artifacts and T2 effects). These effects are discussed in terms of their dependence on concentration and their dependence on the degree of transplant malfunction. The appearance of "dark-ring patterns" and of susceptibility artifacts indicate the functional status of the glomerular filters.

[Magnetic resonance tomography of kidney transplants--status of diagnostic possibilities]

It is the aim of the use of magnetic resonance tomography to reduce the existing insufficiency in imaging diagnostics of complications after kidney transplantation. In this report the most recent status of examination technique is presented and the criteria of normal and pathological MRT findings are described in detail.

CT diagnosis of hepatic adenoma

Only few publication have so far been known on case histories in the context of CT-findings of hepatic adenoma (HA). An analysis was, therefore, made of the findings of ten patients with HA. Precontrast and postcontrast scans (dynamic CT), densitometric evaluations (gamma-fit) and "profile" determination were taken into consideration. Diagnostic relevance is attributed to two types of features (with and without tumour haemorrhage) as well as to complementary findings (capsule-like structure and fat-ring around the tumour, island-like areas).

[CT diagnosis of focal nodular hyperplasia]

The paper analyses the findings of a CT study of 21 lesions of focal nodular hyperplasia in 17 patients. In addition to subjective valuatin of the dynamic studies, densitometric measurements on a time basis were carried out (gamma-fit curves) and a density profile was obtained. These tumour-like lesions show typical density changes with rapid enhancement in the arterial phase and rapid fall in density after one or two minutes. Various patterns of the hyperdense lesions (non-homogeneous, those resembling vessels or homogeneous lesions) may be of significance in differential diagnosis. Atypical density patterns were found particularly in foci projecting from the liver.