Clinical Risk Management in radiology. Part II: applied examples and concluding remarks

With the aim of providing a clearer understanding of the tools used for evaluating risk in the radiological setting and how they are applied, this second part presents two practical examples. The first is a proactive analysis applied to CT, whereas the second is a reactive analysis performed following a sentinel event triggered by a CT study allocated to the wrong patient in the RIS-PACS system.

Altered growth pattern, not altered growth per se, is the hallmark of early lesions preceding cancer development

Many human solid cancers arise from focal proliferative lesions that long precede the overt clinical appearance of the disease. The available evidence supports the notion that cancer precursor lesions are clonal in origin, and this notion forms the basis for most of the current theories on the pathogenesis of neoplastic disease. In contrast, far less attention has been devoted to the analysis of the phenotypic property that serves to define these focal lesions, i.e. their altered growth pattern. In fact, the latter is often considered a mere morphological by-product of clonal growth, with no specific relevance in the process. In the following study, evidence will be presented to support the concept that focal growth pattern is an inherent property of altered cells, independent of clonal growth; furthermore, it will be discussed how such a property, far from being merely descriptive, might indeed play a fundamental role in the sequence of events leading to the development of cancer. Within this paradigm, the earliest steps of neoplasia should be considered and analysed as defects in the mechanisms of tissue pattern formation.

Chiral resolution and molecular modeling investigation of rac-2-cyclopentylthio-6-[1-(2,6-difluorophenyl)ethyl]-3,4-dihydro-5-methylpyrimidin-4(3H)-one (MC-1047), a potent anti-HIV-1 reverse transcriptase agent of the DABO class

rac-2-Cyclopentylthio-6-[1-(2,6-difluorophenyl)ethyl]-3,4-dihydro-5-methylpyrimidin-4(3H)-one (MC-1047) is a potent inhibitor of HIV-1 multiplication in acutely infected cells. MC-1047 racemate has been resolved by chiral HPLC using, as chiral stationary phase (CSP), a commercially available (R,R)-Whelk-01 column. The optical purity and the circular dichroism (CD) of the two resolved enantiomers were determined and their biological activities tested in in vitro assays. Molecular modeling inspection of the binding of (R) and (S) enantiomers to the non-nucleoside binding site (NNBS) of reverse transcriptase (RT) using the defined model of F(2)-S-DABO/RT complex indicates the (R) enantiomer as the more active isomer.

[Ultrasonographic study of Peyronie's disease]

Induratio penis plastica (IPP) is a degenerative disease, which consists in a thickening of the albuginea tunica of cavernous corpora, especially on the dorsal aspect. In 25% of the cases a calcified deposit is present. This disease can determine a bending of the penis, usually upward, pain during erection and impotentia coeundi. It is associated with Dupuytren's disease in 25% of the cases. IPP is of unknown etiological origin. The more reliable etiological theories are the degenerative one (micro trauma and inflammation) and the autoimmune one. The assessment of IPP is based on story, physical examination, autophotography (which are necessary) and on imaging techniques such as ultrasound, color Doppler, CT, MRI and X-ray in mammography. Color Doppler has demonstrated to be the best technique because of its cost/benefit and cost/effectiveness ratio. RMI with gadolinium can determine plaques activity but it has a lower cost/benefit ratio. Color Doppler can determine the presence of an IPP plaque and its status, which is size, location, and degree of calcification. Some authors sustain that inflammation can be suggested by the presence of micro vascularization around the plaque. US can be very useful to detect plaque in a size not easily accessible by physical examination (on the dorsal aspect of the penis) and to demonstrate plaques in different evolution moment. Ultrasonography is the better technique to show directly albuginea tunica. Authors illustrate the methodology, which use intra-cavernous injection of prostaglandin E1 (PGE1) to induce erection and its semeiotic findings.

Computer-assisted design, synthesis and biological evaluation of novel pyrrolyl heteroaryl sulfones targeted at HIV-1 reverse transcriptase as non-nucleoside inhibitors

Three pyrrolyl heteroaryl sulfones (ethyl 1-[(1H-benzimidazol-2(3H)one-5-yl)sulfonyl]-1H-pyrrole-2-carboxyla te, ethyl 1-[(1H-benzimidazol-5(6)-yl)sulfonyl]-1H-pyrrole-2-carboxylate and ethyl 1-[(1H-benzotriazol-5(6)-yl)sulfonyl]-1H-pyrrole-2-carboxylate) were designed as novel HIV-1 reverse transcriptase non-nucleoside inhibitors using structure-based computational methods. Although these compounds were inactive in the cell-based assay, they inhibited the target enzyme with micromolar potency (IC50s = 2 microM, 3 microM and 9 microM, respectively).