HDLive ultrasound images of ovarian dermoid cysts: diagnostic accuracy

OBJECTIVE

To demonstrate that the use of 3D/4D HDLive increases the image quality in the diagnosis of benign cystic ovarian teratomas.

MATERIALS AND METHODS

3D/HDLive ultrasound (US) was used in 31 cases of suspected ovarian cystic teratoma using vaginal 2D US. The following pathognomonic images of mature cystic teratomas were considered for diagnosis: 1) a cystic, unilocular lesion with a densely echogenic tubercle (Rokitansky nodule); 2) a diffuse or partially echogenic mass usually demonstrating sound attenuation; 3) fluid-fluid/fat-fluid levels; 4) dermoid mesh with hyperechogenic calcifications indicating the presence of bone, teeth, or other ectodermally-derived structure; 5) multiple mobile spherical structures (fat globules).

RESULTS

Dermoids present a wide spectrum of images depending on the predominant tissue type. In the vast majority of cases there are dense echogenic structures that correspond to complex masses of fatty tissue, sebum, hair, epithelial remnants, along with cartilage or bone. If we catalogue all the images together, the pathognomonic of dermoid are: 1) cystic or solid cystic lesions with a Rokitansky nodule, with bone, teeth or cartilage (six cases, 22.2%); 2) a solid mass with or without attenuation that corresponds with pure sebum (five cases, 18.5%); 3) a diffuse mass with fine bands that correspond with hair inside sebum (four cases, 12.9%) and that may form meshes or plugs corresponding with a mixture of fat, sebum, and hair (three cases, 11.5%).

CONCLUSIONS

HDLive U.S. provides some images of exceptional quality that enhance the definition of the structures of these tumors (fat, hair, cartilage, bone, etc.) compared to 2D/3D/4D.

Semi-automatic Sono T measurement of nuchal translucency

A prospective study of 63 singleton pregnancies between 11 + 0 and 13 + 6 weeks gestation underwent semi-automatic nuchal translucency (NT) measurement and were compared with two-dimensional ultrasonography (2D US). Inter-observer variation and the repeatability were evaluated. Sono T automatically achieves mid-sagittal plane views and measures the maximum NT thickness. Measurements have less inter-observer variation (CI = -0.13, -0.04) when compared with 2D measurements (CI = -0.45, 0.28). It is reproducible and comparable to conventional 2D US technique for NT measurement. However, incorporating Sono T into routine practice requires further program refinements in order to reduce erroneous NT measurements.

Predicting ovarian reserve and reproductive outcome using antimüllerian hormone (AMH) and antral follicle count (AFC) in patients with previous assisted reproduction technique (ART) failure

PURPOSE OF INVESTIGATION

The main objective of our prospective, observational, analytical research work was to determine whether Anti-Müllerian hormone (AMH) and antral follicle count (AFC) could be effectively used as predictors of ovarian reserve and, possibly, of reproductive outcome with ART.

METHODS

We studied 143 IVF/ET cycles in patients with a previous history of ART failure, all of them supposed to be of poor prognosis, who had agreed to another ART attempt after knowing their AMH, AFC, and base hormone (FSH, LH, 17 beta-estradiol) levels.

RESULTS

AMH and AFC showed a positive correlation with the number of oocytes retrieved (p = 0.0016) and (p < 0.0001), respectively and with percentage of MII oocytes, (p = 0.00756) and (p < 0.001). The combined use of these markers showed an area under the curve of 82.2% for oocytes retrieved. Our results shows a very high cancelation (22% of started cycles) and very low pregnancy rates (6.7% and 9.8%) in low and normoresponders, respectively.

CONCLUSIONS

AMH levels and AFC are reliable indicators of ovarian reserve. Patients with ovarian reserve levels that predict a very low probability of success should be informed that the poor prognosis associated with these values may not justify the expense of IVF/ET.

Nonlinear optical waveguides generated in lithium niobate by swift-ion irradiation at ultralow fluences

A novel method to produce optical waveguides is demonstrated for lithium niobate (LiNbO(3)). It is based on electronic excitation damage by swift ions, i.e., with energies at approximately 1 MeV/amu or above. The new technique uses high-energy medium-mass ions, such as Cl, with electronic stopping powers above the threshold value for amorphization (5-6 keV/nm), reaching the maximum value a few micrometers inside the crystal. At the ultralow fluence regime (10(12)-10(13) cm(-2)) an effective nanostructured medium is obtained that behaves as an optical waveguide where light propagates transversally to the amorphous nanotracks created by every single impact. The method implies a reduction of 4 orders of magnitude with respect to He implantation. The optical waveguides present reasonable losses (~10 dB/cm) and significant second-harmonic generation (SHG) and electro-optic (EO) responses (>50% bulk) for the lowest fluences.

Usefulness of basal and pilocarpine-stimulated salivary flow in primary Sjögren's syndrome. Correlation with clinical, immunological and histological features

OBJECTIVES

To examine salivary function in patients with primary Sjögren's syndrome (SS) by assessing unstimulated and stimulated flows using 5 mg of pilocarpine in a 5% solution, in order to define their clinical usefulness in the evaluation of xerostomia in patients with primary SS as well as to identify those factors related to the increase in salivary flow after pilocarpine stimulation.

METHODS

We investigated the clinical and immunological characteristics of 60 consecutive patients with primary SS. All patients fulfilled four or more of the preliminary diagnostic European criteria for SS. We measured unstimulated (basal) salivary flow (BSF) in all patients. In patients with BSF </=1.5 ml, stimulated salivary flows (SSF) were also measured after stimulation with an ophthalmic 5% pilocarpine solution (0.1 ml=5 mg, administered sublingually). SSF was also measured after oral administration of 50 mg anetholetrithione (ANTT) in the same patients. These stimulated salivary flows were measured 1, 2 and 3 h after the stimulus.

RESULTS

Of the 60 patients, 55 were women and five men, with a mean age at the SS onset of 61 yr (range 18-82 yr). The mean BSF for SS patients was 1.40+/-0.17 ml. Fifty (83%) patients showed a BSF less than 1.5 ml. The stimulated salivary flow after 1 h was 3.23 ml in the pilocarpine group and 0.57 in the ANTT group (P<0.001); after 2 h it was 1.32 ml in the pilocarpine group and 0.52 in the ANTT group (P=0.02) and after 3 h it was 0.80 ml in the pilocarpine group and 0.41 in the ANTT group (P=0.046). No clinical or immunological differences were found between SS patients with BSF more or less than 1.5 ml, although patients with a BSF less than 1.5 ml showed a parotid scintigraphy class III or IV more frequently (42 vs 0%, P=0.01). SS patients with a pilocarpine SSF less than 1.5 ml had a longer duration of SS (73.3 vs 31.3 months, P=0.03) and a higher prevalence of positive anti-Ro/SS-A (70 vs 36%, P=0.038), anti-La/SS-B (65 vs 32%, P=0.038), parotid scintigraphy class III-IV (79 vs 9%, P<0.001) and positive salivary gland biopsy (90 vs 43%, P<0.001).

CONCLUSION

The study of xerostomia using basal and pilocarpine SSF is simple to perform, acceptable to patients and needs no special equipment. We describe a significant increase in SSF using a solution of 5% pilocarpine in comparison with salivary flow obtained after stimulation with ANTT. Twenty-two of the 46 patients with low BSF had stimulated flows over 1.5 ml. These 'responder' patients showed a shorter duration of sicca symptoms, a lower frequency of positive immunological markers and milder grades of scintigraphic patterns and lymphocytic infiltrates in salivary gland biopsies. This subset of patients probably maintain a residual capacity of their salivary glands, as opposed to the 'non-responder' patients, who had a longer duration of sicca syndrome evolution with more severe involvement of the salivary glands.

A gene related to yeast HOS2 histone deacetylase affects extracellular depolymerase expression and virulence in a plant pathogenic fungus

A gene, HDC1, related to the Saccharomyces cerevisiae histone deacetylase (HDAC) gene HOS2, was isolated from the filamentous fungus Cochliobolus carbonum, a pathogen of maize that makes the HDAC inhibitor HC-toxin. Engineered mutants of HDC1 had smaller and less septate conidia and exhibited an approximately 50% reduction in total HDAC activity. Mutants were strongly reduced in virulence as a result of reduced penetration efficiency. Growth of hdc1 mutants in vitro was normal on glucose, slightly decreased on sucrose, and reduced by 30 to 73% on other simple and complex carbohydrates. Extracellular depolymerase activities and expression of the corresponding genes were downregulated in hdc1 mutant strains. Except for altered conidial morphology, the phenotypes of hdc1 mutants were similar to those of C. carbonum strains mutated in ccSNF1 encoding a protein kinase necessary for expression of glucose-repressed genes. These results show that HDC1 has multiple functions in a filamentous fungus and is required for full virulence of C. carbonum on maize.

Comparison between antigenemia and a quantitative-competitive polymerase chain reaction for the diagnosis of cytomegalovirus infection after heart transplantation

BACKGROUND

Antigenemia and quantitative polymerase chain reaction (PCR) are widely used for cytomegalovirus (CMV) diagnosis after heart transplantation due to their enhanced predictive values for disease detection when specific cut-off values are used. The purpose of this study was to compare, in the same patient setting, the predictive values of quantitative PCR and antigenemia for CMV disease detection, using specific cut-off values.

METHODS

Thirty heart transplant receptors were ch prospectively monitored for active CMV infection and disease detection, using quantitative PCR and anti- po genemia. Positive and negative predictive values for pr CMV disease detection were calculated using cut-off pr values for both antigenemia (5 and 10 positive cells/300,000 neutrophils) and quantitative-PCR (50,000 and 100,000 copies/10(6) leukocytes).

RESULTS

Active CMV infection was diagnosed in 93.3% of patients and CMV disease in 23.3%. The positive and negative predictive (%) values for CMV disease detection were 35/100 and 46.7/100, respectively, for quantitative PCR and antigenemia. Using 5 and 10 positive cells/300,000 neutrophils as cut-off values for antigenemia, the positive and negative predictive values (%) for disease detection were respectively 63.6/100 and 70/100. For quantitative PCR, the positive and th negative predictive values (%) for cut-off values of to 50,000 and 100,000 copies/10(6) leukocytes were 53.8/100 and 60/94.1, respectively.

CONCLUSION

In our series, antigenemia and quantitative-PCR had enhanced and similar predictive values for CMV disease detection when specific cut-off values were used. The choice between these two methods for disease detection may rely less on their efficiency and more on the experience and familiarity with them.

[Abdominal scintigraphy with 99MTc-HMPAO-labelled leukocytes. Utility of the quantification in the evaluation of the inflammatory activity of Crohn's disease and ulcerative colitis]

We aimed to determine the activity of Crohn's Disease (CD) and Ulcerative Colitis (UC) with this radiotracer and to compare it with the normal clinical indexes. 32 patients with CD (19 women) and 18 with UC (13 women) were studied and a sequential abdominal 99mTc-HMPAO-label leukocyte scintigraphy was performed after evaluating the activity clinical scales indexes (Harvey's for CD and Lictiger for UC). Quantification was performed to obtain intestinal activity indexes in regards to intestinal uptake with background, bone marrow, liver and spleen, comparing them with the clinical indexes. In CD, all scintigraphic indexes showed a significant correlation (p < 0.001) with clinical activity. The best results were obtained with gut/background (r: 0.73) and gut/bone marrow (r: 0.72). In UC, we obtain a lower correlation between clinical and scintigraphic indexes. Significant correlations (p < 0.05) were only found with the gut/background (r: 0.52) and gut/bone marrow growth indexes (r: 0.58). The others showed no correlation. In conclusion, IBD activity estimated with 99mTc-WBC and scintigraphy indexes showed moderate correlation with clinical scales. However, the information of the scintigraphy was very useful in the management of these patients.

[Reversible hyperparathyroid metabolic osteopathy secondary to parathyroid carcinoma]

Parathyroid carcinoma is a rare cause of hyperparathyroidism and metabolic osteopathy. The authors report a patient with parathyroid carcinoma who underwent 99mTc-Sestamibi parathyroid and 99mTc-MDP bone scanning. These techniques showed the parathyroid lesion and typical features of severe metabolic osteopathy respectively. The bone scan performed at only four months after surgery showed near complete resolution.

[Cerebral blood flow study using SPECT in patients with memory disorders]

INTRODUCTION

Global amnesia (AG) is a dysfunction of memory, in which there is a sudden incapacity to remember recent events and assimilate new information. The aetiology is currently under discussion. The main hypotheses under consideration are an ischemic mechanism and an epileptic mechanism.

OBJECTIVE

To study the cerebral blood flow in patients with temporary global amnesia (AGT) or permanent global amnesia (AGP) using functional neuroimaging techniques.

MATERIAL AND METHODS

Four patients were studied. Two had severe alterations of fixation memory which had been present for months. The other two had a sudden loss of recent memory, although space-person orientation and immediate memory remained normal. In all cases the cerebral blood flow (FSC), was assessed by single photon emission tomography (SPECT), using Tc-HMPAO as the radio tracer.

RESULTS

We describe 4 patients, 2 men and 2 women aged between 42 and 64.2 with AGT and the others with AGP. On SPECT there was temporal hypoperfusion in all 4 patients. In 2 cases there was associated parietal hypoperfusion and in 1 case there was frontal hypoperfusion.

CONCLUSIONS

These findings suggest that AGT and AGP are of vascular origin and that SPECT is a useful diagnostic technique in patients with AG.

[Recurrent rectorrhagia caused by angiodysplasia of the colon localized exclusively by scintigraphy with Tc-99m red blood cells]

A case of angiodysplasia of the colon with clinical manifestation of massive rectal bleeding is presented. The activity and the severity of the life-threatening bleeding episode led to emergency exploratory laparotomy with intraoperative colonoscopy which was not diagnostic. Three years later, following multiple recurrent bleeding episodes and non diagnostic explorations, the localization of the hemorrhage was obtained by abdominal scintigraphy with 99mTc-red blood cells. Surgical removal of the affected area achieved definitive cure.

[Ulcerative colitis and colonic angiodysplasia associated with a lower digestive hemorrhage. Their diagnosis by 99-technetium-labelled red blood cells]

We describe a case of a patient with previously diagnosed of ulcerative colitis, who was admitted to the hospital because of rectal bleeding and abdominal pain. A mild active colitis was reported by colonoscopy with biopsy. Rectal bleeding relapsed, and an arteriovenous malformation in the transverse colon compatible with angiodysplasia was located by early vascular scintigraphy with 99m-technetium-labeled red blood cells. This finding was confirmed by selective arteriography. Four months after hemicolectomy, the patient is free of rectal bleedings. Labeled red blood cell scintigraphy may be useful to differential diagnosis of lower digestive hemorrhage.

[Gammagraphy with 123I-meta-iodobenzylguanidine in the diagnosis of pheochromocytoma]

At times pheochromocytoma raises diagnostic problems which cannot be solved by methods already incorporated into diagnostic evaluation, such as catecholamine measurement, echography and computed tomography. These drawbacks are more common with small size tumors, malignant extra-adrenal pheochromocytoma and some cases of relapse after surgery. The present study reports the results of 123I-meta-iodobenzylguanidine (MIBG) scintiscan in 30 patients with suspected pheochromocytoma. The head, the thorax and the abdomen were scanned in all patients after 3, 24 and 48 hours. Areas of normal and abnormal uptake were evaluated in these areas. The scintiscan was positive in seven cases with a diagnosis of pheochromocytoma, which showed markedly increased uptake persisting throughout the study. The results of other studies are analyzed and the functional character of MIBG, its sensitivity and specificity, and the advantages of 123I over 131I are discussed.

[131I-MIBG-meta-iodobencylguanidine (131I-MIBG) in the study of neuroblastoma]

Ten patients with neuroblastoma were scintigraphed with I131-meta-iodobenzylguanidine (MIBG). Lugol solution was previously administered orally to all patients in order to avoid uptake of radioactive iodide by the thyroid gland. The compound was injected intravenously, 0.5 mCi/1.73 m2 of body surface. Scintigraphy was performed at 24, 48 and 72 hours and 6-7 days after administration of the radioactive preparation. Positive radiotracer uptake was demonstrated in all primitive tumors and metastases, showing a positivity of 100%. MIBG has proven to be the most useful technique in defining the stage of the disease. Mechanism of the tumoral uptake in relationship to catecholamine metabolism is discussed. Differences observed in MIBG radioactivity seen in the urinary bladder, heart and liver in children with or without. Neuroblastoma are discussed. MIBG has also been useful in the follow-up of patients with neuroblastoma.

Visualization of a ganglioneuroma by means of scintigraphy with 131-I-MIBG

A case report of ganglioneuroma secreting catecholamines is presented. The 131-I-MIBG gammagraphy was positive. We conclude that an uptake of 131-I-MIBG is not synonimous of a malignant tumour.

[Extraskeletal manifestations of unusual localization in a case of myeloma (author's transl)]

A 46-year-old woman presented and IgG myeloma without metastases at the time of the diagnosis. A complete hematologic remission was achieved with melphalan and prednisone, but the patient then developed a polysymptomatic condition with myelomatous metastases in different organs. In some cases these were confirmed histologically (meninges, stomach, skin, and scalp); in others there was a strong clinical evidence (liver, oral mucosa, lymph nodes, and lumbar vertebra). There were manifestations of the disease in all of these sites, while complete hematologic remission was maintained. The meningeal metastasis was treated by surgery and irradiation with orbital penetration; the lymph nodes were irradiated, and COPP polychemotherapy was given to treat the rest of the metastatic localizations. In this way an apparently remission was achieved temporarily. The incidence of each one of the extraskeletal manifestations in this unusual case of myeloma is reviewed in the literature.