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PubMed2003

Aggressive resection is indicated for cecal diverticulitis.

BACKGROUND: Because of the difficulties in preoperative diagnosis and controversies in the management, cecal diverticulitis has received much discussion in the literature. There, however, are still many questions that remain unanswered. METHODS: During a 5-year period, 112 patients with a clinical diagnosis of cecal diverticulitis were treated. Twenty-seven patients were excluded because of uncertainty in diagnosis or incomplete data collection, leaving 85 patients as the study group. The diagnosis of cecal diverticulitis was made by pathology, surgical findings, or image study. RESULTS: Nonoperative management was applied to 18 patients initially. Three patients had recurrent diverticulitis during follow up. These patients responded satisfactorily to another course of medical treatment. Laparotomy was performed in 67 patients. Acute appendicitis was the preoperative diagnosis in 47 patients (70%). Of the other 20 patients, 6 received operation because of repeated attack of diverticulitis, 7 had preoperative computed tomography (CT) diagnosis of cecal diverticulitis with perforation, 5 had preoperative diagnosis of cecal tumor, and 2 had medical treatment failure. All these 20 patients received right hemicolectomy. In the 47 patients with a preoperative diagnosis of acute appendicitis, 24 received appendectomy, 9 received diverticulectomy, and 14 received right hemicolectomy. Overall, 34 patients received right hemicolectomy, 9 received diverticulectomy, and 24 received appendectomy only. In the right hemicolectomy group, there were 2 deaths with underlying diseases and 5 complications. In the appendectomy group, there was no postoperative mortality, but in 7 patients recurrent diverticulitis developed. Three of them required right hemicolectomy. CONCLUSIONS: The natural history of cecal diverticulitis varies from benign and self-limiting to fulminant in the oriental population. Less than 40% (32 of 85) of patients were successfully treated with conservative methods initially and had no recurrence during the follow-up period. We recommend aggressive surgical resection for patients with a definite diagnosis. Adjuvant appendectomy without resection of the lesion should be considered only in uncomplicated patients whose diagnosis is in doubt.

Acute Disease↗

PubMed2001

Renal cell carcinoma: incidental detection during routine ultrasonography in men presenting with lower urinary tract symptoms.

OBJECTIVE: To compare renal cell carcinomas (RCCs) presenting incidentally in patients referred for lower urinary tract symptoms (LtJTS) with those presenting symptomatically, by stage, intervention and outcome. PATIENTS AND METHODS: The case notes of all male patients (100) diagnosed with RCC between 1991 and 1998 were reviewed and modes of presentation recorded. The patients were divided into two groups: those who were referred with LUTS (frequency, urgency, hesitancy, poor stream, nocturia) and in whom RCC would not have been suspected and was thus detected incidentally on routine ultrasonography; and all patients in whom carcinoma might have been suspected from their symptoms but, for the purposes of this study, also included patients in whom RCC was diagnosed during ultrasonography for unrelated intra-abdominal pathology. Details of diagnostic imaging and clinical staging were similarly recorded for both groups and where surgical intervention was undertaken, histopathological data were also noted. The clinical course and long-term outcome of incidentally detected tumours was then compared with their symptomatically presenting counterparts. RESULTS: The mean (range) follow-up for all patients was 30 (1.5-96) months; for those in the incidental group it was 31 (1-86) months and in the symptomatic patients 29 (1-96) months. Organ-confined disease was found in two-thirds of patients with incidental tumours and in 38% of those in whom the tumour may have been suspected; the difference was statistically significant (chi-squared test P<0.05). The mean (SD) size of tumours discovered incidentally and in symptomatic patients was 5.9 (1.94) cm and 9.2 (3.39) cm, respectively; this difference was also statistically significant (t-test, P<0.001). Of the 24 patients with incidentally detected tumours, 14 (58%) were alive with no recurrence, and of the 76 presenting symptomatically, 27 (35%) were alive with no recurrence at the last follow-up; disease survival curves showed a statistically better survival rate for those with organ-confined tumours. CONCLUSION: Incidentally diagnosed RCC represents a significant proportion of those who are ultimately diagnosed with the malignancy. Opportunities which arise for appropriate screening of the upper tracts during routine urological investigations (e.g. ultrasonography of the upper tracts in patients referred for LUTS) should be endorsed, contrasting with the more traditional approach, which argues that it yields no ultimate survival advantage.

Carcinoma, Renal Cell↗

PubMed2005

Mood disorder with psychotic features, schizoaffective disorder, and schizophrenia with mood features: trouble at the borders.

Psychiatry has long struggled with the problem of how to understand the relationship between psychotic symptoms and mood symptoms. In the past, these debates were over conceptualizations of categories based on syndromal definitions of mental illnesses. Ample data now exists that provide insight into the biologic basis for syndromal distinctions. We examine the syndromes of mood disorder with psychotic features, schizoaffective disorder, and schizophrenia with mood features, reviewing their classification, clinical features, course, and treatment. We provide evidence that, clinically, mood disorders and schizophrenia do not separate neatly. We will also review data arising from studies in brain imaging, molecular neurobiology, and genetics. Evidence is accumulating that overlap across diagnostic boundaries for both pathologic and etiologic factors exist, along with disorder-specific factors. The nosology that will carve the reality of psychotic illness at the joints awaits further advances in genetics and neurobiology. Or, alternatively, carving out categories may turn out to be less useful for some purposes than considering dimensions.

Diagnosis, Differential↗

PubMed1996

Acoustic nonlinearity parameter tomography for biological specimens via measurements of the second harmonics.

The acoustic nonlinearity parameter B/A is a new parameter in ultrasound tissue characterization. In this paper, on the basis of a theoretical analysis of finite amplitude ultrasonic wave propagation in fluidlike media, an experimental system for nonlinearity parameter tomography is developed. Using this system, the amplitude of the second harmonic wave cumulated in the propagation path of the primary wave is measured and the finite amplitude insert-substitution method is used in the conventional computer tomography (CT) technique. The filtered convolution algorithm is implemented using the amplitude of the second harmonic as the projection data, then the B/A tomography can be reconstructed. The B/A images for several biological samples are obtained. Besides, the image of porcine pathological liver tissue is studied and is compared with that of porcine normal liver tissue. These results show the potential applications of the nonlinearity parameter B/A in medical diagnosis.

Animals↗

PubMed1982

CT of benign cystic teratomas.

The computed tomographic (CT) findings in nine benign cystic teratomas are presented and compared with radiographic, sonographic, and pathologic data. CT rendered a specific diagnosis in six cases and was highly suggestive in two, with results superior to other imaging methods. In each instance, CT was successful in predicting or excluding invasion of adjacent structures, but was not reliable in predicting or excluding adherence to them. Specific CT characteristics of benign cystic teratomas are predominantly fatty mass with a denser dependent element and globular calcification, bone, or teeth in a solid protuberance into the cyst cavity. Suggestive patterns include fatty mass with rim calcification and water density mass with globular calcification and solid tissue elements. Illustrated for the first time are the CT appearances of the different calcifications seen in benign cystic teratomas.

Abdominal Neoplasms↗

PubMed2002

[Optimum mode of interventional treatment for hepatocellular carcinoma].

OBJECTIVE: To establish a reasonable protocol for interventional treatment of hepatocellular carcinoma (HCC). METHODS: The data of 1 000 HCC patients treated by different kinds of interventional treatment were reviewed with their results of biochemistry, imaging, pathology and survival rate evaluated. The value as well as the pros and cons of these various kinds of interventional treatment were compared in order to find an optimum protocol. RESULTS: Segmental-transcatheter oil chemoembolization (S-TOCE) was much effective eradicate the tumor yet inflicting less damage on the noncancerous hepatic tissue and giving much higher survival rate than the conventional transcatheter oil chemoembolization (C-TOCE). Percutaneous ethanol injection (PEI) played an important role in eradicating the residual tumor and improving the survival rate without damaging the noncancerous hepatic tissue. The survival quality or survival rate could be improved by choosing different ways of interventional treatments to cut down the complications. CONCLUSION: The selection of different interventional treatments should be done according to the size and type of HCC. Active management is indicated for different complications presenting along with HCC.

Carcinoma, Hepatocellular↗

PubMedDate not supplied

Asymmetrical FDG-PET and MRI findings of striatonigral system in multiple system atrophy with hemiparkinsonism.

The asymmetry of the local cerebral metabolic rate for glucose (lCMRglc) and magnetic resonance (MR) imaging was studied in five patients with multiple system atrophy (MSA) presenting hemiparkinsonism. lCMRglc was measured with 18F-2-fluoro-2-deoxy-D-glucose and positron emission tomography (PET) in these patients and five normal control subjects. MR images were obtained in five patients and 11 control subjects. In all patients, T2-weighted MR images showed hypointense areas in the posterior lateral putamen. They were bigger or lower in intensity on the contralateral side than on the ipsilateral side. Significant glucose hypometabolism was found in the posterior putamen on the contralateral side to hemiparkinsonism. A significant decrease in size was found in the contralateral putamen, caudate nucleus, and pars compacta of the substantia nigra. However, no significant correlation was seen between PET and MRI data. In the control subjects, no apparent asymmetry was observed. PET and MR imaging demonstrated the characteristic asymmetry corresponding to the pathological findings reported in MSA.

Brain↗

PubMed1987

[Magnetic resonance in the study of the adrenal glands].

Current usage of MR in the clinical study of adrenal pathology is assessed with a review of the advantages and limitations of this new imaging technique and a critical analysis of data deriving both from the literature and from personal experience. The possibility of a multiplanar study offered by MR permits a more accurate anatomical-topographical definition of the adrenal masses though it is not yet capable of the tissue characterisation that would diagnose the nature of the lesion, though it can differentiate between inert adenomas and metastases.

Adenoma↗

PubMed2005

Internet-based Profiler system as integrative framework to support translational research.

BACKGROUND: Translational research requires taking basic science observations and developing them into clinically useful tests and therapeutics. We have developed a process to develop molecular biomarkers for diagnosis and prognosis by integrating tissue microarray (TMA) technology and an internet-database tool, Profiler. TMA technology allows investigators to study hundreds of patient samples on a single glass slide resulting in the conservation of tissue and the reduction in inter-experimental variability. The Profiler system allows investigator to reliably track, store, and evaluate TMA experiments. Here within we describe the process that has evolved through an empirical basis over the past 5 years at two academic institutions. RESULTS: The generic design of this system makes it compatible with multiple organ system (e.g., prostate, breast, lung, renal, and hematopoietic system,). Studies and folders are restricted to authorized users as required. Over the past 5 years, investigators at 2 academic institutions have scanned 656 TMA experiments and collected 63,311 digital images of these tissue samples. 68 pathologists from 12 major user groups have accessed the system. Two groups directly link clinical data from over 500 patients for immediate access and the remaining groups choose to maintain clinical and pathology data on separate systems. Profiler currently has 170 K data points such as staining intensity, tumor grade, and nuclear size. Due to the relational database structure, analysis can be easily performed on single or multiple TMA experimental results. The TMA module of Profiler can maintain images acquired from multiple systems. CONCLUSION: We have developed a robust process to develop molecular biomarkers using TMA technology and an internet-based database system to track all steps of this process. This system is extendable to other types of molecular data as separate modules and is freely available to academic institutions for licensing.

Automation↗

PubMed2004

The sensitivity of 18-fluorodopa positron emission tomography and magnetic resonance imaging in Parkinson's disease.

Parkinson's disease (PD) as the most important movement disorder is characterized by a progressive loss of nigral dopamine neurons and a subsequent degeneration within several other transmitter systems. Functional brain imaging with positron emission tomography (PET) and the radiotracer 18-fluorodopa (FDOPA) is capable to quantify the deficiency of dopamine synthesis and storage within pre-synaptic striatal nerve terminals. Therefore, FDOPA-PET allows the diagnosis of PD in early disease stages and the differentiation of clinically unclear cases from other movement disorders, e.g. essential tremor. Additionally, FDOPA-PET imaging permits the follow-up of disease progression, the assessment of medical and surgical PD therapy strategies with possible neuroprotective properties and the detection of pre-clinical disease in subjects at risk for the disorder. The classical domain of morphological magnetic resonance imaging (MRI) is the differentiation of symptomatic Parkinsonism from PD. However, recent advances in MRI data acquisition and analysis techniques demonstrated MRI to be also a valuable tool for detection of nigral pathology in PD and for differentiation of neurodegenerative disorders with atypical Parkinsonism.

Brain↗

PubMed1995

MRI in cerebral developmental malformations and epilepsy.

Cerebral developmental malformations are increasingly recognized as a major cause of developmental delay and epilepsy. The incidence of these developmental malformations in patients with epilepsy is not known, but epilepsy surgery data suggest that this pathology is commonly seen in children who undergo epilepsy surgery for intractable epilepsy. These malformations can be diagnosed by a combination of clinical, neurophysiological, and imaging techniques. However, imaging techniques such as MRI have been able to provide in vivo recognition of many of these malformations and have contributed to the recognition of specific syndromes. These malformations can be classified on an anatomical basis either into diffuse, unilateral, or generalized. However, a combination of imaging data in conjunction with genetics and embryology may be more appropriate in the future. Further technical developments promise to increase the sensitivity of MRI in detecting these malformations and may help to delineate the possible biology of these disorders.

Brain↗

PubMed2004

Computer-generated three-dimensional animation of the mitral valve.

OBJECTIVE: Three-dimensional motion-capture data offer insight into the mechanical differences of mitral valve function in pathologic states. Although this technique is precise, the resulting time-varying data sets can be both difficult to interpret and visualize. We used a new technique to transform these 3-dimensional ovine numeric analyses into an animated human model of the mitral apparatus that can be deformed into various pathologic states. METHODS: In vivo, high-speed, biplane cinefluoroscopic images of tagged ovine mitral apparatus were previously analyzed under normal and pathologic conditions. These studies produced serial 3-dimensional coordinates. By using commercial animation and custom software, animated 3-dimensional models were constructed of the mitral annulus, leaflets, and subvalvular apparatus. The motion data were overlaid onto a detailed model of the human heart, resulting in a dynamic reconstruction. RESULTS: Numeric motion-capture data were successfully converted into animated 3-dimensional models of the mitral valve. Structures of interest can be isolated by eliminating adjacent anatomy. The normal and pathophysiologic dynamics of the mitral valve complex can be viewed from any perspective. CONCLUSION: This technique provides easy and understandable visualization of the complex and time-varying motion of the mitral apparatus. This technology creates a valuable research and teaching tool for the conceptualization of mitral valve dysfunction and the principles of repair.

Animals↗

PubMed2005

Intraoperative landmarking of vascular anatomy by integration of duplex and Doppler ultrasonography in image-guided surgery. Technical note.

BACKGROUND: The integration of ultrasound technology into neuronavigation systems has recently been the subject of reports by several groups. This article describes our preliminary findings with regard to the integration of data derived from intraoperative duplex (color mode) and Doppler ultrasonography into a neuronavigational data set. It was the aim of the study to investigate (1) whether the intraoperative landmarking of vessels that are outlined with ultrasound technology is possible and (2) whether such a technique might be of clinical interest for neurosurgical interventions. METHODS: The video image of an ultrasound plane (Toshiba, Powervision 6000 SSA-370A, Tokyo, Japan) was integrated into our neuronavigation system (VectorVision2, BrainLab, Heimstetten, Germany). For calibration of the ultrasound plane, an instrument adapter was fixed to the ultrasound probe and then calibrated using a special, predefined calibration phantom. RESULTS: Accordingly, the system supported a combination of the ultrasound plane functionality with the preoperatively acquired neuronavigational data. The duplex and Doppler mode of the ultrasound system displayed the intraoperative vascular anatomy. Once a vessel was outlined during surgery, it could be landmarked by touching the navigation screen. These landmarks were integrated automatically into the neuronavigational data set and could be used to provide intraoperative image updates of the vascular anatomy. This technique was successful in 45 of 47 (95.7%) surgical interventions. CONCLUSIONS: Both image-guided ultrasound and duplex-guided integration of vascular anatomy into the neuronavigational data set are technically possible. In the future, this technology may provide useful intraoperative information during surgery of complex cerebral pathologies.

Blood Vessels↗

PubMed1993

MR appearance of multiple myeloma of the spine before and after treatment.

OBJECTIVE: The aim of this study was to describe the changes in the MR appearance of painful lesions of the spine before and after treatment in 18 patients with multiple myeloma and to correlate these changes with the clinical response to treatment. SUBJECTS AND METHODS: Eighteen patients with multiple myeloma and tumor nodules in the spine had MR imaging of the same site in the spine before and after treatment. Unenhanced T1- and T2-weighted spin-echo images, dynamic ultrafast low-angle shot (turbo-FLASH) images before and after IV bolus injection of paramagnetic contrast material, and contrast-enhanced T1-weighted spin-echo images were obtained. Characteristic signal and contrast enhancement before and after treatment were compared and were correlated with clinical data and the results of immunochemical and pathologic tests. RESULTS: Changes in signal intensity and enhancement of the lesions occurred after treatment in 14 of 18 patients. The characteristics of the lesions after treatment had three patterns: (1) rim enhancement or no enhancement of the lesions, (2) early enhancing lesions associated with other nonenhancing lesions or lesions with rim enhancement, and (3) no change from the enhancement pattern seen before treatment. In 13 of 18 patients, these patterns correlated well with the response to treatment. A discrepancy was observed in five patients. CONCLUSION: The MR appearance of spinal myeloma is different before and after treatment. MR images, particularly contrast-enhanced images, may be helpful in monitoring the response to treatment of focal bone lesions of myeloma.

Combined Modality Therapy↗

PubMed2006

Pathological diagnosis of paediatric tumours from image-guided needle core biopsies: a systematic review.

BACKGROUND: Image-guided core needle biopsy is widely used in paediatric oncology, but many protocols continue to discourage this practice. No published randomized studies compare image-guided needle biopsy with surgical techniques. OBJECTIVE: To perform a systematic review of the literature on image-guided core needle biopsy in paediatric oncology. MATERIALS AND METHODS: Several computerized databases were searched using the terms [(needle OR core) AND (biops*[ti]) AND (paediatric OR pediatric OR child OR children OR childhood OR boy OR girl)[ti]] to identify series of more than five cases of needle core biopsy for tumour diagnosis in children. Data from included studies were combined to calculate pooled estimates of adequacy, accuracy and complication rates. RESULTS: Thirteen studies fulfilled the inclusion criteria. Overall biopsy adequacy rate (defined as sufficient to make a diagnosis) was 94% (95% CI 92-96%). The diagnostic accuracy rate in cases with adequate material (defined as achieving the correct specific diagnosis) was 94% (95% CI 92-96%). Complications requiring treatment occurred in 1%. CONCLUSIONS: Available pooled data suggest that about 95% of image-guided needle core biopsies provide an adequate sample for diagnosis of malignant disease in childhood. In such cases, the pathological diagnosis is correct in about 95%. Complications are rare.

Biopsy, Needle↗

PubMed1999

Effect of whole-body vibration on the low back. A study of tractor-driving farmers in north India.

STUDY DESIGN: A retrospective cohort study of tractor-driving farmers (study group) and non-tractor-driving farmers (control group) matched for age, gender, generic/ethnic group, land-holding, and work routines. OBJECTIVES: To determine, using magnetic resonance imaging and clinical investigations, the effect of whole-body vibrations on the back in tractor-driving farmers. SUMMARY OF BACKGROUND DATA: Low back pain and pathologic changes in the lower backs of tractor drivers have been reported. However, no study with a control group matched for work-related risk factors has been reported. METHODS: Fifty tractor-driving farmers were compared with 50 non-tractor-driving farmers matched for age, gender, ethnic group, land-holding, and work routine. Both groups were interviewed for details of work routine, assets held, family profile, and vibration exposure to assess the influence of these parameters on signs and symptoms of backache. Magnetic resonance imaging was done to assess the effect of exposure on whole-body vibration and degenerative changes in the back. Vibration measurements also were done on tractors to observe the actual severity of the vibrations. RESULTS: Regular work-related backache was more common among tractor-driving farmers (40%) than among non-tractor-driving farmers (18%, P = 0.015). Anthropometric evaluation showed abdominal girth and weight to be significantly higher in tractor-driving farmers (P = 0.006 and 0.046, respectively), whereas while height and arm span were similar between the two groups. Clinical examination for evidence of disc or facet degeneration showed no difference between the two groups. Evaluation of magnetic resonance images of tractor-driving farmers and non-tractor-driving farmers by an orthopedic surgeon, radiologist, and neurosurgeon showed degenerative changes to be similar between the two groups (P > 0.050). CONCLUSIONS: Tractor-driving farmers report backache more often than non-tractor-driving farmers, but no significant objective differences on clinical or magnetic resonance imaging evaluation were found between the two groups.

Adult↗

PubMed1984

Evaluation of renal masses by MR imaging.

Magnetic resonance (MR) imaging was performed in 20 subjects, 10 of whom had benign or malignant renal masses, and 10 were normal volunteers. The purpose of the study was to evaluate the ability of MR to provide significant diagnostic information in the management of renal mass lesions. Ten normal patients were included to supply baseline data. Different pulse sequences were used and their contribution to the diagnosis was evaluated. The emphasis has been placed on evaluating MR against the pathological diagnosis rather than other imaging modalities.

Adenocarcinoma↗

PubMed1986

Dynamic isotopic phlebography using soluble krypton-81m.

Intravenous peripheral injection of krypton-81m in an isotonic solution permits venous scintigraphy of the lower limbs to be carried out. An anatomic definition of the obstructions and the collateral pathways is therefore easily displayed from the popliteal vein to the vena cava. The physical characteristics of the radionuclide permit iterative or sustained perfusions without accumulation of an excessive background noise and the method is used to obtain scintigraphic images in changing physiological conditions. Analysis of the dynamic data permits venous stasis to be assessed in terms of regional radioactivity at a steady state and transit rate. Various physiological and pathological conditions are analyzed by this method.

Hemodynamics↗