Two cases of synovitis, acne, pustulosis, osteitis--SAPHO syndrome

Synovitis, acne, pustulosis, osteitis (SAPHO) syndrome is rare with yet unknown prevalence. The difficulty in recognizing the syndrome is due to the very wide diversity of its signs and symptoms, the lack of skin manifestations in many cases and to confusion in medical terminology in describing this syndrome. In this paper, we present two cases with characteristic bone lesions in bone scan and in radiology images that are considered to be SAPHO syndrome. In the first case the characteristic bone single photon emission tomography scan findings in a patient with spine involvement supposed by bone biopsy but were not followed by characteristic skin manifestations. The point of interest of this case lies on the significant improvement of both symptoms and scintigraphic findings after treatment with biphosphonates. In the second case the diagnosis was also based on the characteristic bone scan findings, although the patient referred to us for staging of prostate cancer. Detailed history and clinical examination revealed skin manifestations of the syndrome.     

The effects of TTS-scopolamine, dimenhydrinate, lidocaine, and tocainide on motion sickness, vertigo, and nystagmus

The effects of TTS-scopolamine, dimenhydrinate, lidocaine, and tocainide on motion sickness and vertigo and on caloric and postrotatory nystagmus were evaluated in healthy volunteers. TTS-scopolamine was administered transdermally (delivering approximately 10 micrograms X h-1 scopolamine base) and 100 mg dimenhydrinate orally. Lidocaine and tocainide were administered intravenously (average plasma concentration of lidocaine 6 mol X L-1 and of tocainide 20 mol X L-1). TTS-scopolamine and dimenhydrinate significantly reduced vertigo induced by calorization of the ears, nausea provoked with Coriolis maneuvre, and nystagmus in caloric and rotatory tests. During treatment with lidocaine and tocainide no alleviation of vertigo and nausea was observed. Caloric nystagmus was reduced but rotation induced nystagmus was virtually unchanged. Presumably the motion sickness drugs act at the brain stem where TTS-scopolamine and dimenhydrinate have their target cells in the vestibular nuclei. Furthermore, the alleviation of motion sickness was linked to a decline of nystagmus. Lidocaine and tocainide, the action of which in vertigo and nausea in patients is proposed to be on the vestibular end organs and the supratentorial brain structures, consistently failed to alleviate motion sickness.     

Diagnostic performance of regional DTI-derived tensor metrics in glioblastoma multiforme: simultaneous evaluation of p, q, L, Cl, Cp, Cs, RA, RD, AD, mean diffusivity and fractional anisotropy

Objectives

Almost a dozen diffusion tensor-imaging (DTI) variables have been used to evaluate brain tumours with scarce information about their diagnostic ability. We aimed to perform a comprehensive evaluation of tensor metrics reported in the last decade.

Methods

Retrospective case control study performed in 14 patients with glioblastoma multiforme (GBM) and 28 controls. Conventional brain MR sequences and image postprocessing of DTI allowed the calculation of: MD, FA, p, q, L, Cl, Cp, Cs, RA, RD and AD, classified into five regions: normal appearance white matter (NAWM), immediate and distant oedema, enhancing rim and cystic cavity. ANOVA and AUROC analyses were performed.

Results

ANOVA depicted a significant difference among all metrics (p?<?0.05). RA had the highest performance in the NAWM and cystic cavity; immediate and distant zones of oedema were best diagnosed by RD and Cp respectively; q was the best biomarker of the enhancing rim zone; p?<?0.001 for all metrics.

Conclusions

FA and MD, accepted biomarkers of brain injury, were surpassed by other metrics. RA, together with Cs, Cl and CP, might be the new leaders in the evaluation of brain tumours. DTI tensor metrics depict different clinical applicability at each tumour region.

Key Points

? DTI-derived tensor metrics can characterise the regional impairment of intraaxial brain tumours. ? A performance evaluation of new diagnostic tests should follow the STARD initiative. ? Each tumour region in GBM is detected by a different tensor metric. ? FA and MD are not the best biomarkers of tumour infiltration. ? The diagnostic performance of some tensor metrics allows them to be used interchangeably.     

Renal venography: Anatomy,technique, applications,analysis of 132 venograms,and a review of the literature

Selective renal venography is a simple but important diagnostic procedure which has few complications. A thorough knowledge of renal venous anatomy is essential for its proper performance and clinical application. This is particularly true because renal venous variations are frequent and may interfere with the successful approach to retroperitoneal surgery. The method is widely accepted for the evaluation of the renal venous bed in patients with suspected renal vein thrombosis or hematuria of unknown etiology. It depicts the extent of renal venous involvement in renal carcinoma and clarifies the diagnosis in some patients with avascular tumors, renal pelvic carcinoma, and retroperitoneal tumors. It may also be useful in defining the morphologic abnormality when the kidney fails to visualize on urography, in delineating the extent and nature of renal parenchymal disease, and in enhancing the precision of renal vein renin collection. This work was supported in part by USPHS grants HL20895, GM 18674, and HL07734