High-fidelity inference of local impurity profiles in C-2W using Bayesian tomography

In C-2W (also called "Norman") [1], beam-driven field reversed configuration plasmas embedded in a magnetic mirror are produced and sustained in a steady state. A multi-chord passive Doppler spectroscopy diagnostic provides line-integrated impurity emission measurements near the center plane of the confinement vessel with fast time resolution. The high degree of plasma non-uniformity across optical sightlines can preclude direct fitting of the measured line-integrated spectra. To overcome this challenge, local impurity profiles are inferred using Bayesian tomography, a superior analysis technique based on a complete forward model of the diagnostic. The measured emission of O⁴⁺ triplet lines near 278.4 nm is modeled assuming two independent populations: thermal and beam ions. Gaussian processes are used to generate and infer local profiles. The inference incorporates details of the geometrical arrangement of the diagnostic, instrument function, intensity calibration, and a noise model. Markov chain Monte Carlo (MCMC) sampling of the posterior distribution of solutions provides high-fidelity uncertainty estimates. The reconstructed O⁴⁺ impurity profiles are consistent with data from other diagnostics and show good agreement with expected physics based on previously developed models of biasing circuit and impurity transport.

Bayesian inference and calibration of magnetic diagnostics

The magnetic diagnostics across TAE Technologies' compact toroid fusion device include 28 internal and 45 external flux loops that measure poloidal flux and axial field strength, 64 three-axis (radial, toroidal, and axial) Mirnov probes, and 22 internal and external, axial-only Mirnov probes. Imperfect construction, installation, and physical constraints required a Bayesian approach for the calibration process to best account for errors in signals. These errors included flux loops not fitted to a perfect circle due to spatial constraints, Mirnov probes not perfectly aligned against their respective axes, and flux pickup that occurred within the insert (feedthrough) of the Mirnov probes. Our model-based calibration is derived from magnetostatic theory and the circuitry of the sensors. These models predicted outputs that were compared against experimental data. Using a simple least-squares optimization, we were able to predict flux loop data within 1% of relative error. For the Mirnov probes, we utilized Bayesian inference to determine three rotation angles and three amplifier gains. The results of this work not only gave our diagnostic measurements physical meaning, but also act as a safeguard to spot when instruments have malfunctioned, or when there is an error in database maintenance. This paper will go into the details of our calibration procedure, our Bayesian modeling, and the accuracy of our results compared to experimental data.

Safety and tolerability of targeted therapies for pulmonary hypertension in children

The objective of this study is to evaluate the safety and tolerability of the pharmacological treatment of pulmonary hypertension in pediatric patients. It is a retrospective, longitudinal, observational study on pediatric patients undergoing treatment with pulmonary targeted therapies. 63 patients were included (51% male), with a median age of 3.4 years (IQR, 3.6 months-10 years) and a median weight 13 kg (IQR, 6-30 kg). Congenital heart disease was the etiology of pulmonary hypertension in the majority of cases (n = 33) and 28 patients were in NYHA functional class III-IV. The most commonly used drug was sildenafil (n = 79, 56%), followed by bosentan (n = 27, 23%), and a combination of both (n = 14, 41%). 34 patients had adverse reactions (54%) with an incidence rate of 1.02 per patient per year. The most commonly reported reactions were gastrointestinal symptoms (22%) and spontaneous erections (22%) in males. Nine severe adverse reactions (10%) occurred, requiring eight treatment withdrawal and one hospital admission. Treatment with targeted therapies for pulmonary hypertension is safe in the pediatric population. Severe ADRs were uncommon both in monotherapy and in combination therapy. Combination therapy was associated with a higher rate of ADRs. We observed similar survival rates in children receiving sildenafil doses according to the European Medicines Agency (EMA) recommendations or higher.

Application of the analysis of serum antibodies (immunoglobulins M and G) to estimate the seroprevalence of ovine oestrosis and to evaluate the effect of chemotherapy

The analysis of immunoglobulin (Ig) M and IgG serum isotypes as indicators of the presence of Oestrus ovis developmental stages was carried out. A serological survey to discover the seasonal variations in the prevalence of oestrosis in sheep from an oceanic climate area was developed. Six hundred and sixty-nine blood samples were analyzed for the presence of IgM and IgG using an enzyme-linked immunosorbent assay and O. ovis second-stage larvae excretory/secretory antigens. In addition, the effect of an ivermectin-based treatment on the humoral immune response was measured. The percentage of positive animals was 54% for IgM and 55% for IgG. The highest percentages of sheep positive to IgM were recorded in the winter and to IgG in the summer. No animals positive to IgM were detected in the ivermectin-treated sheep. These results seem to underline that oestrosis is a parasitic disease to keep watch for in regions with an oceanic climate. A noninvasive evaluation of the success of chemotherapy seems possible by analyzing the serum IgM response.

Diffraction by a circular aperture: an application of the vectorial theory of Huygens's principle in the near field

A vectorial theory that brings new insight into the nature of diffraction is used to obtain mathematical expressions that evaluate diffraction patterns in the near field. The equations allow us to discriminate between the contributions of the vectorial and the scalar approaches. In the near field we studied the pattern of light diffracted through a circular aperture, and it was proved that the vectorial approach is significant in a region very near the circular aperture. In spite of the obvious differences between the circular aperture and other obstacles, the present theory may also be used with other geometries.

Huygens's secondary-sources dimensions

Using a vectorial formulation, we show that Huygens's secondary-sources density is constant in plane waves, and it depends only on the wavelength. We also illustrate that Huygens's secondary sources, which act as emitters of secondary wavelets, have a finite dimension equal to 3 pi/2k(2).

Subcutaneous ossifying fibromyxoid tumor

Ossifying fibromyxoid tumor (OFMT) is an uncommon neoplasm occurring predominantly in the deep soft tissues of the trunk and proximal extremities. The lineage of this rare tumor to date is still uncertain. We present a case of a subcutaneous OFMT that recurred 8 years after initial resection. The histological findings of the primary and recurrent lesions are compared along with the histologic features possibly associated with aggressiveness. Dermatopathologists should consider OFMT in the differential diagnosis of subcutaneous neoplasms with a myxoid matrix.

Analysis of the humoral immune response to Oestrus ovis in ovine

Antibody responses (IgG, IgM and IgA) against Oestrus ovis were analyzed in sheep and in first year grazing lambs from Sardinia (Italy) by an indirect-enzyme-linked immunoassay test and L2 O. ovis excretory/secretory antigens. Serum samples from 208 sheep were obtained prior to be slaughtered, and then heads were removed and cut open along their longitudinal axis to collect the parasites from the nasal cavities, turbinates and sinus. Besides this, blood samples were monthly collected from the lambs of G-1 (maintained under field conditions) and the lambs of G-2 (kept housed since birth to avoid Oestrus infestations) throughout a year. In the sheep, a positive significant correlation was observed between the number of first instar O. ovis larvae and the values of IgM, and between the second instar larvae and the IgG optical densities. In the lambs, all classes of antibodies increased significantly from July in G-1. The highest values of IgG were reached in September (IgG) and decreased in November-December. The IgM response peaked in November, and very low values of IgA were observed during the study. Matching these data with chronobiology of O. ovis in this region, we conclude that the first infection occurs on May, stimulating the production of humoral antibodies. The reduction of the IgG antibody levels starting from October means the beginning of the diapause while the IgM response seems to be associated to the presence of L1 in the nasal cavities. The data obtained led us to forecast an early treatment of the ovine on June-July, which should keep away from the maturation of O. ovis L1 larvae, avoiding the development of clinical lesions and interrupting the life cycle of this parasite.

Pulmonary arterial fibromuscular dysplasia: a rare cause of fulminant lung hemorrhage

Arterial fibromuscular dysplasia (FMD) represents a collection of noninflammatory and nonatherosclerotic vascular diseases with a poorly understood etiology. Classically occurring in renal and cerebral arteries, this entity has also been reported in coronary, carotid, and other medium and small arteries. One case occurring in the pulmonary vasculature has been reported. Fatal hemothorax and lung hemorrhage have multiple causes, including other vascular malformations and connective tissue disorders; however, cases of pulmonary FMD are exceedingly rare. We report what appears to be the second such association, occurring in a 69-year-old man. The patient presented with a 3-week history of increasing dyspnea, fatigue, and productive cough; 3 days of increasing back and chest pain; and syncope. Chest radiograph showed a "white-out" of the left lung. The patient died shortly after admission from a fulminant respiratory disease of undetermined etiology. At autopsy he was found to have a massive left hemothorax resulting from an unsuspected pulmonary arterial fibromuscular dysplasia.

Isoniazid overdose: recognition and management

Since isoniazid is increasingly being used to control the spread of tuberculosis, physicians must be aware of its potentially fatal effects. The ingestion of toxic amounts of isoniazid causes recurrent seizures, profound metabolic acidosis, coma and even death. In adults, toxicity can occur with the acute ingestion of as little as 1.5 g of isoniazid. Doses larger than 30 mg per kg often produce seizures. When ingested in amounts of 80 to 150 mg per kg or more, isoniazid can be rapidly fatal. The first signs and symptoms of isoniazid toxicity usually appear 30 minutes to two hours after ingestion and include nausea, vomiting, slurred speech, dizziness, tachycardia and urinary retention, followed by stupor, coma and recurrent grand mal seizures. The seizures produced by isoniazid toxicity are often refractory to anticonvulsant therapy. Given in gram-per-gram amounts of the isoniazid ingested, pyridoxine (vitamin B6) usually eliminates seizure activity and helps to correct the patient's metabolic acidosis. Isoniazid toxicity should be suspected in any patient who presents with refractory seizures and metabolic acidosis.

Musculoskeletal complications of neutron therapy for prostate cancer

The purpose of this study was to investigate the cause of hip complaints following conformal neutron therapy delivered by opposed lateral and oblique anterior ports to treat prostate cancer. Twenty-seven patients with hip complaints following neutron or mixed neutron and photon therapy for prostate cancer had 34 magnetic resonance imaging (MRI) studies 3-39 (mean 15.3) months following treatment; for comparison, 13 similarly treated patients without hip complaints were imaged 1-32 (mean 13.8) months post-treatment; 25/40 imaged patients received concurrent nonsteroidal hormone therapy. Coronal and axial images of the hips/pelvis were obtained utilizing T1 weighted spin echo and fat suppressed inversion recovery (STIR) sequences. Signal amplitude (SA) of involved muscles was measured on the STIR images and normalized to that of the psoas outside the treatment field. Hip complaints ranged from mild soreness or motion limitation to severe pain and limitation of ambulation; presence and severity of symptoms (sx) were significantly related to neutron dose (P = 0.020 and 0.0001) but not to hormone therapy (each P > 0.17). Normalized SA of the obturator muscles differed significantly with neutron dose (P = 0.013), the presence, and the severity, of sx (P = 0.0002 and 0.0007); estimated extent of abnormal muscle also differed significantly with neutron dose (P = 0.039), presence, and severity, of sx (P = 0.00004 and 0.0007); [hormone treatment had a profound effect on SA (P = 0.0001) and extent (P = 0.005) which was independent of sx (P = 0.10 and 0.14, respectively) and neutron dose (P = 0.33 and 0.32, respectively)]. Subcutaneous changes localized lateral to the greater trochanter were seen in all, and edema of the subjacent gluteus muscles in many, symptomatic hips; only 4/13 asymptomatic hips showed subcutaneous changes, 6 had mild gluteus edema. Avascular necrosis of the femoral head was seen in 5 symptomatic hips, with marked acetabular necrosis in 3 of these; small joint effusions were seen in 8 symptomatic hips; asymptomatic hips had no significant bone or joint abnormalities. Neutron therapy for prostate cancer designed to spare the rectum results in significant dose-dependent, musculoskeletal complications which are well demonstrated by MRI. SA abnormalities of irradiated muscle correlate significantly with neutron dose and both presence and severity of hip sx. Protocol modifications have been implemented to reduce these complications. MRI provides an objective means to assess both complications and the success of new protocols in ameliorating them. Concurrent hormone therapy has a profound effect on muscle changes on MRI which is independent of neutron dose and sx.

Erdheim-Chester disease demonstrated by bone radiograph and scans

Two cases of patients with Erdheim-Chester disease (EC) are presented with interesting scintigraphic findings. Differential diagnosis of bone scan and radiographic findings is briefly discussed.

[Usefulness of the angiographic examination of the left internal mammary artery in patients candidates for coronary bypass surgery]

BACKGROUND AND OBJECTIVE

The usefulness of preoperative angiographic evaluation of the internal mammary artery (IMA) is controversial. The aim of this study is to evaluate the problem by a basic cost-benefit analysis.

METHODS

One hundred and twenty-one patients whose coronary findings (left main disease and/or severe stenosis of the left anterior descending artery) made use of the IMA as a bypass graft a consideration were studied. The IMA was cannulated by the same right Judkins catheter used in the coronarography; the specific catheter was only used if the cannulation was not successful with the right Judkins. We measured the time it took for a good angiography of the IMA to be obtained; the anatomy and the size for each IMA were studied and compared with the size of the left anterior descending artery.

RESULTS

An optimal angiographic picture of the IMA was obtained in 119 cases (98.3%); a specific catheter was used only in 3 patients. The mean of the time employed was 170 seconds (8-900 s) and no complications were related to IMA cannulations. Angiography findings relevant to any planned surgery were demonstrated in 15 patients (12%): large proximal branches (10); occlusion stenosis or a caliber insufficient for IMA (3); and occlusion or proximal subclavian stenosis (2).

CONCLUSIONS

We have observed that the relation between the cost and the obtained information is adequate to warrant its performance, because angiographic findings relevant to planned surgery can be very important, even though they are fairly infrequent. Moreover, these findings can be achieved rapidly without additional cost.

Resistivity and adhesive strength of thin film metallizations on single crystal quartz

Resistivity and adhesive strength were measured for the thin films 450 A Cr-1800 A Au, 450 A Cr-1000 A Mo-1800 A Au, 450 A Cr-1000 A Ni-1800 A Au, 450 A Mo-1800 A Au, 1800 A Au, and 2000 A Al on z-and AT-oriented single crystal quartz substrates in the as-deposited condition as well as after thermal annealing at 380 degrees C and 450 degrees C for 30 min in air or vacuum. The Cr-Au films exhibited significant resistivity increases after thermal annealing which were caused by the interdiffusion of Cr and Au. Barrier layers of Mo or Ni limited such increases after heat treatment. The Mo-Au, Au, and Al films exhibited resistivity decreases following thermal annealing. The mean adhesive strengths of the Cr-Au, Cr-Mo-Au, and Cr-Ni-Au films were excellent in the as-deposited and annealed conditions, ranging from 41 MPa to 70 MPa. The Mo-Au and Au films maintained relatively poor adhesion under all circumstances. Heat treatment improved the poor adhesive strength of the as-deposited Al films to values exceeding 63 MPa. Resistivity and adhesive strengths did not differ significantly between the z- and AT-oriented substrates.

Effect of quercitrin on acute and chronic experimental colitis in the rat

Quercitrin was tested for acute and chronic anti-inflammatory activity in trinitrobenzenesulfonic acid-induced rat colitis. The inflammatory status was evaluated by myeloperoxidase, alkaline phosphatase and total glutathione levels, leukotriene B4 synthesis, in vivo colonic fluid absorption, macroscopical damage and occurrence of diarrhea and adhesions. Treatment with 1 or 5 mg/kg of quercitrin by the oral route reduced myeloperoxidase and alkaline phosphatase levels, preserved normal fluid absorption, counteracted glutathione depletion and ameliorated colonic damage at 2 days. Increasing or lowering the dose of the flavonoid resulted in marked loss of effect. The acute anti-inflammatory effect of quercitrin is unrelated to impairment of neutrophil function or lipoxygenase inhibition, and it may be caused by mucosal protection or enhancement of mucosal repair secondary to increased defense against oxidative insult and/or preservation of normal colonic absorptive function. When tested in chronic colitis (2 and 4 weeks), quercitrin treatment (1 or 5 mg/kg.day) decreased colonic damage score and the incidence of diarrhea, and normalized the colonic fluid transport. All other parameters were unaffected. The chronic effect of the flavonoid is apparently related to its action on colonic absorption, although it can be partly secondary to its acute beneficial effect.

Recurrent ovarian endodermal sinus tumor: demonstration by computed tomography, magnetic resonance imaging, and positron emission tomography

We report a case of recurrent endodermal sinus tumor of the ovary that was identified and/or clearly depicted by computed tomography, magnetic resonance imaging, and positron emission tomography. The potential roles of various imaging modalities in the detection of recurrent endodermal sinus tumor are discussed.

Different biologic features of desmoid tumors in adult and juvenile patients: MR demonstration

OBJECTIVE

To demonstrate different biologic features of desmoid tumors on MRI between juvenile and adult patients.

MATERIALS AND METHODS

We have retrospectively analyzed clinical records and 121 MRI findings in 40 patients (8 juveniles and 32 adults) with proven desmoid tumors. The Fisher exact test and Kaplan-Meier curve were utilized for statistical analysis.

RESULTS

Recurrences in the juvenile patients were more multiple (50 vs 12%) and appeared significantly earlier than in the adult patients. Adult patients demonstrate a much greater recurrence-free rate (p = 0.0001). Infiltrative pattern was significantly predominant in the juvenile patients (63%) whereas the nodular pattern was more frequent in the adult patients (81%). Low-signal intensity zones on T1- and T2-weighted imaging as well as the type of contrast enhancement did not show any significant relationship with biological behavior. Four cases with no significant contrast enhancement showed low signal intensities on T2-weighted imaging.

CONCLUSION

Magnetic resonance demonstrates different biologic features between juvenile and adult patients with histologically same desmoid tumors. These differences may be useful in consideration of MRI follow-up studies.

The value of exercise electrocardiography testing in the identification of coronary restenosis: a probability analysis

We studied by means of probability analysis the role of exercise ECG in identifying coronary restenosis. A total of 213 patients were independently evaluated by clinical history, conventional assessment of the exercise ECG ('yes or no' statement), D score (a discriminant function derived from exercise ECG), and coronariography, 5.4 +/- 2.8 months after successful coronary angioplasty. The initial probability of restenosis (30%), that is, the prevalence of the condition, was radically changed by the result of clinical history (77% for patients with angina vs. 17% for those without angina). By contrast, ECG binary assessment, due to its low accuracy (70% vs 82% of clinical history, P < 0.005), was unable to significantly change the established probabilities after symptomatic evaluation. Finally, D score, which greatly enhanced specificity (92% vs. 76% of bivariate assessment, P < 0.0001), proved to be useful in changing the probability (from 32% to 76% or to 25%) of patients (n = 34) with a discordant result (no angina/positive exercise ECG). When this stepwise approach was tested in 46 new patients, predicted and observed probabilities were actually very similar. We conclude that exercise ECG has a very limited role in identifying coronary restenosis if positive responses are not adjusted with a weighted score which takes into account other exercise derived factors.

Bladder wash flow cytometry in transitional cell carcinoma: useful or misleading?

To evaluate the practical usefulness of flow cytometry (FC) applied to bladder wash specimens for the diagnosis of transitional cell carcinoma (TCC), a study was conducted on a series of 101 cases comprising 60 patients with tumor or with past history of TCC, and a control group of 41 patients undergoing cystoscopy for causes other than TCC in which the absence of tumor was confirmed after 1 year of follow-up. When results of the 33 patients with tumor were compared with those of the control group, FC gave low specificity and positive predictive values (54% and 58%, respectively). Conventional cytologic study was superior to FC in this setting. Although the combination of both techniques increased the sensitivity for low-grade tumors, specificity remained lower than that of cytologic study alone. Otherwise, when considering only the cases with a past history of TCC, results of FC were superior to those of cytologic examination, and the combination of both techniques gave high sensitivity and negative predictive values (94% and 93%, respectively). In conclusion, the use of FC in a general diagnostic setting could be misleading, whereas in the follow-up of patients with a history of TCC it becomes a useful adjunct to cytologic study in order to obtain a high diagnostic performance that could allow cystoscopies to be spaced out in these patients.

MR characteristics of epithelioid sarcoma

OBJECTIVE

The purpose of this study was to characterize MRI findings of epithelioid sarcomas and correlate them with the presence or absence of metastasis and/or recurrence.

MATERIALS AND METHODS

Thirty-six MRI studies were analyzed retrospectively in 12 patients with histologically proven epithelioid sarcomas. The following parameters were evaluated: lesion location, signal characteristics, and bone or vascular involvement. Also, the time of the appearance and the frequency of local recurrences were determined, as well as location, frequency, and timing of appearance of metastatic disease.

RESULTS

Epithelioid sarcomas were located mainly in the upper extremities (58%). The MRI findings divided the tumor into two major categories: hemorrhagic (two patients) and nonhemorrhagic (ten patients). The study showed recurrence in 33% of the cases and metastasis in 50% overall. Both patients with hemorrhagic epithelioid sarcoma showed metastases that appeared earlier than metastases from nonhemorrhagic sarcomas. Only 33% of the nonhemorrhagic sarcomas showed metastases; and 17% of the cases revealed vascular invasion.

CONCLUSION

Magnetic resonance plays a role in recognizing intratumoral hemorrhage in patients with epithelial sarcoma. Patients with hemorrhagic tumors need more aggressive treatments and follow-up studies.

MRI of recurrent cystic mesothelioma: differential diagnosis of cystic pelvic masses

A case of recurrent cystic pelvic mesothelioma in a woman who developed pelvic fullness, frequent urination, and pressure sensation in the lower abdomen with interesting magnetic resonance imaging findings is presented. The differential diagnosis of cystic pelvic masses is briefly discussed.

[Bladder lavage cytology in the diagnosis and follow-up of superficial bladder cancer]

Classical mictional cytology (MC) has a series of widely recognized limitations for the diagnosis and follow-up of surface vesical carcinoma (SVC). A prospective study was conducted in 171 patients with suspected signs and symptoms or a background of SVC using cystoscopy, MC and vesical lavage cytology (LC). Overall sensitivity was 98.8%, 45.4% and 66.6% respectively. LC showed a significant difference (p < 0.05) when compared to MC in suspected disease with no SVC background, and follow-up with endovesical prophylaxis.

[Acute peritonitis as a clinical manifestation of xanthogranulomatous pyelonephritis]

Xanthogranulomatous pyelonephritis can become clinically apparent in a variety of manners. The paper contributes a very infrequent presentation; a picture of acute peritonitis following non-focal generalized toxic syndrome and haematuria episodes.

Seminal vesicle abscess: two case reports and a review of the literature

Two new cases of seminal vesicle abscess diagnosed by computerized tomography and treated with percutaneous drainage are reported. A review of the 8 cases published so far is also presented.

Enzyme elevations in the neuroleptic malignant syndrome

Enzyme elevations are frequently observed in neuroleptic malignant syndrome (NMS), but their significance is unknown and their source is uncertain. In this study the relationship of serum enzymes to creatine phosphokinase (CPK) in NMS is examined. Thirty-seven patients with at least one probable episode of NMS were studied, and 83 consecutive newly admitted psychiatric patients constituted a comparison group. Serum levels of lactate dehydrogenase (LDH), glutamic oxaloacetic transaminase (GOT), aldolase, and alkaline phosphatase (AP) were compared to serum CPK levels in each patient group. Except for AP, all enzymes were significantly correlated with CPK in both groups. However, correlations were much higher in the NMS group, and regression lines for CPK-LDH and CPK-GOT pairs differed significantly between patient groups. These data strongly suggest that a common process underlies the enzyme elevations frequently seen in NMS, that these enzymes originate in muscle tissue, and that these findings are not caused solely by agitation or psychological stress. It is likely that increased production and selective "leakage" of enzymes from myocytes play a role in this process.

[Probability analysis of the value of ergometry in the detection of restenosis after coronary angioplasty]

To evaluate the usefulness of treadmill exercise test in the diagnosis of coronary restenosis, we have chosen a sequential and probabilistic analysis. The rate of coronary restenosis found in the sample (n = 213) was of 30%. This initial probability of having restenosis was radically changed by the recurrence of typical angina: 77% in patients with this symptom, 17% in those without (p < 0.001). In contrast, the qualitative result of the exercise test was unable to change significantly the probabilities established after anamnesis. This was due to a lower specificity for exercise test (76%) than for angina (93%), the sensibility being the same (56%) for both. Employment of a discriminant value that integrates different ergometric variables did not enhanced sensibility, but allowed the identification of a good number of false positive results and therefore palliated the negative impact of faulty specificity. Being applied to a "discordant group" (no angina/positive exercise test, n = 34) was able to achieve a significant change in probability: from 15% to 50% or 4% (p < 0.01), according to the discriminant being lesser or greater than a preestablished value. In conclusion, prevalence of the event and evaluation of symptomatology are both important to estimate the probability of suffering coronary restenosis. On the contrary, exercise test, in the absence of a weighty method, adds more confusion than clarity to the analysis of the problem. Our results can be used to improve the follow-up of patients who have been successfully dilated by angioplasty.

Invasive bladder cancer in women

A total of 84 radical cystectomies were performed for invasive bladder cancer in 67 men (79.8%) and 17 women (20.2%). The present study investigated the possible sex-dependent differences in the pattern of invasive bladder cancer. More than 40% of the women presented lower urinary tract syndrome alone or with haematuria, giving a clinical picture similar to acute cystitis. This caused an average time-lag in diagnosis of 18.5 months in the women and 8 months in the men. There was a higher frequency of non-transitional cell carcinoma in the women (17.6%) than in the men (2.9%). We found statistically significant differences (p < 0.005) in tumor grade: 35.2% of the women had low grade tumors, compared to 7.4% of the men. However, no significant differences in staging or survival rate were found when comparing the two sexes. This leads us to believe that bladder cancer is less aggressive in women.

Sympathoadrenomedullary activity in the neuroleptic malignant syndrome

Many clinical features of the neuroleptic malignant syndrome suggest that sympathetic nervous system hyperactivity is involved in the pathophysiology of this disorder. Only a few studies have examined levels of catecholamines or their metabolites in patients with NMS; results so far have been inconclusive. In the present study urinary catecholamine metabolites obtained during the course of NMS were studied with respect to frequently reported signs and symptoms of NMS. The principal findings are that (1) elevated urinary catecholamines and metabolites are a frequent but inconstant feature of NMS; (2) it is likely that sympathetic nervous system hyperactivity contributes to the picture of fulminant NMS; and (3) the role of the adrenal medulla in producing excess catecholamines during NMS is uncertain.

Late-onset atypical psychosis: a case involving neuroleptic drug toxicity and autoimmune serological abnormalities

Serious or significant neuroleptic toxicity (Kurlan et al. 1984; Lazarus 1985; Levenson 1985; Pearlman 1986) may complicate the diagnosis and management of patients who develop acute medical problems while under treatment with neuroleptics (Levenson and Simpson 1986). We have found that in some cases it is difficult, if not impossible, to determine whether neuroleptics have contributed to the cause of an acute medical illness, or if the occurrence of acute medical problems precipitated the signs of neuroleptic toxicity by altering the disposition or the pharmacologic effects of the drugs.

[Adrenal myelolipoma: our experience and a review]

Four additional cases of adrenal myelolipoma that had been treated at our hospital are reported. All patients were male, aged 31-59 years. The largest diameter of the tumor ranged from 7-10 cm. Only one of the cases was symptomatic (arterial hypertension). In the remaining 3 patients with unremarkable clinical findings, the tumor and been detected incidentally during patient evaluation with CT and ultrasound (US) for other pathologies. Treatment was by surgery for the symptomatic case. For the remaining 3 patients, we adopted a conservative approach that included regular CT or US control evaluation. Treatment of this tumor type continues to be a controversy. Our therapeutic approach is described and the literature reviewed.

A comparison of diagnostic criteria for neuroleptic malignant syndrome

BACKGROUND

A variety of diagnostic criteria for neuroleptic malignant syndrome (NMS) have been used in clinical studies of this disorder, but it is not known if different criteria consistently identify NMS. This study examines agreement between three frequently used sets of diagnostic criteria in a series of possible NMS episodes.

METHOD

All clinically suspected NMS episodes occurring at a large tertiary psychiatric facility during a 6-year period were evaluated by three different sets of diagnostic criteria. Agreement among these criteria was quantified statistically by means of the kappa and intraclass correlation coefficients.

RESULTS

The NMS diagnostic criteria examined generally demonstrated only fair agreement with one another in the diagnosis of NMS. Agreement was best among these criteria when the "probable" category was employed. A complex interaction involving both definition and structure of individual diagnostic criteria and designation of criteria as major or minor appears to contribute to these findings.

CONCLUSION

The published diagnostic criteria used in this study do not consistently identify NMS episodes and demonstrate different thresholds for assigning this diagnosis. These differences are not due solely to different definitions of individual criteria (e.g., fever). Possible implications of these findings for clinical practice and research are discussed.

Right parietal stroke with Gerstmann's syndrome. Appearance on computed tomography, magnetic resonance imaging, and single-photon emission computed tomography

We examined a patient who exhibited Gerstmann's syndrome (left-right disorientation, finger agnosia, dyscalculia, and dysgraphia) in association with a perioperative stroke in the right parietal lobe. This is the first description of the Gerstmann tetrad occurring in the setting of discrete right hemisphere pathologic findings. A well-localized vascular lesion was demonstrated by computed tomography, magnetic resonance imaging, and single-photon emission computed tomographic studies. The patient had clinical evidence of reversed functional cerebral dominance and radiologic evidence of reversed anatomic cerebral asymmetries.

Urinary schistosomiasis with cutaneous lesions

We report a case of urinary schistosomiasis with simultaneous presence of cutaneous lesions in a white male. The literature is reviewed, and the frequency, characteristics and physiopathology are discussed.

Vesical tumors in patients under 25 years of age

Behavior of transitional cell carcinoma of the bladder during the third decade of life remains a controversial subject. During the period 1980-1988, we treated 7 patients (4 male and 3 female), 25 years of age or less (mean age 19.3, range 14-25), with transitional cell carcinoma of the bladder. Until now, all patients are alive and without disease during 12-50 months after surgery. In 6 of the 7 patients, endoscopic resection was the choice treatment for superficial stage A/O. The seventh patient underwent a partial cystectomy for a B1 Jewet stage cell carcinoma. We conclude that transitional cell carcinoma of the bladder in patients under 25 years of age has a less aggressive biological behavior. Therefore, ultrasonographic examinations and serial urine cytology represent the elective test for follow-up. Cystoscopy would only be performed in doubtful cases.

Alpha-interferon and oral fluorouracil in the treatment of unremovable and/or metastatic renal cancer

We present the results obtained in a study of the pharmacological action (phase II) of alpha-interferon and oral fluorouracyl administered in our 2-year study (Feb. 1988-Feb. 1990) in 10 patients suffering from surgically unremovable or metastatic renal cancer. Our results were: 1 patient with complete regression of lung metastasis; 5 with progressive disease within 3-4 months from beginning of treatment and 2 deaths with stable disease after 4-5 months. Two patients abandoned treatment and their disease progressed within 4-5 months.

[Peripheral parenteral nutrition: contribution of nursing to the development, preparation and control protocols]

In the present work the role of nursing in peripheric parenteral nutrition (PPN) is described. The main role is framed within the Unit of Nutritional Support along with the design of the corresponding protocols. The outstanding difference in the composition of our PPN vs those manufactured by the pharmaceutical industry, is the inclusion of glucose as the sole source of carbohydrates. These protocols secure similar nursing care in all patients. With respect to the local venous tolerance to our PPN, it was significantly better than that found in the group infused with a commercial PPN. By contrast, no differences in glycosuria were observed. The economical savings were of 1,980 pesetas per nutrition/day.

[Entero-urinary fistula. A study of 22 cases]

We performed a retrospective study on 22 patients with entero-urinary fistulas that had been diagnosed and treated at the Hospital Clinico i Provincial in Barcelona during the period spanning 1981-1988. Fistulas were classified according to the organs or parts with which they communicated. Among the important etiogenic conditions were diverticular disease of colon. Crohn's disease, actinic lesions, trauma and xanthogranulomatous pyelonephritis. The clinical manifestations were principally urological in the form of recurrent urinary infection and terminal pneumaturia. The most useful diagnostic techniques were cystoscopy; serial voiding cystourethrography (SVCU), retrograde urethrography and pyelography. Treatment was by surgery in all cases. Diversion procedures or surgical excision of the fistulous tract were performed as warranted by each case. The etiopathogenic, morphological and therapeutical aspects of vesico-enteric fistulas are discussed.

[Secondary bladder amyloidosis. A rare cause of hematuria]

Secondary vesical amyloidosis is an uncommon pathology and few cases are described in the literature. A suddenly appearing hematuria resistant to treatment in a patient with a diagnosis of systemic amyloidosis is usually the initial sign that guides us to its diagnosis. We present a case of vesical amyloidosis in a patient with systemic amyloidosis secondary to a Rheumatoid Arthritis of length evolution, and which was diagnosed as a result of a pattern of massive incoercible hematuria.

[Pyonephrosis as a cause of acute peritonitis. Review of the literature and report of a case]

We report on a 52-year-old patient with spontaneous intraperitoneal rupture of pyonephrosis. The diagnostic features, preoperative findings and treatment are discussed and the literature reviewed.

[Diverticulum of the right ventricle]

We report the case of a 38-year-old woman who underwent cardiac catheterization because of cyanosis from birth. This study revealed a right ventricular cavity hypoplasia, an atrial septal defect, and a diverticulum originated from the free right ventricular wall. Ventricular diverticuli, especially those in the right ventricle, are very rare malformations, usually associated with other cardiac defects. The right ventricular diverticulum is generally non-symptomatic, diagnosed by chance, and does not usually require surgical treatment.

Immunogenetic markers in chlorpromazine-induced tardive dyskinesia

The presence and severity of tardive dyskinesia were determined in 66 patients with chronic psychiatric disorders treated with chlorpromazine. The patients were classified according to the presence of antinuclear antibodies, the lupus anticoagulant, and the HLA antigen Bw44. The severity of orofacial dyskinesia was estimated using the Rockland Research Institute Scale. Patients with autoantibodies and the Bw44 antigen had higher tardive dyskinesia scores than those with AAB without the Bw44 antigen and also patients without autoantibodies regardless of their HLA phenotype (P less than 0.01). These studies suggest that the presence of autoantibodies in association with the HLA Bw44 antigen is related to, and can be a predictor of, neurological complications of long-term chlorpromazine therapy.

Carbon monoxide poisoning with features of Gilles de la Tourette's syndrome

A previously healthy 58-year-old man had severe carbon monoxide poisoning. Following a comatose state, tics of the head, coprolalia, fits of shouting, and abnormal vocal utterances developed. In addition to the signs of diffuse encephalopathy, he had some of the features associated with idiopathic Gilles de la Tourette's syndrome. The computed tomographic scan showed ventricular enlargement and low-density areas in the basal ganglia.