Percutaneous renal mass biopsy: historical perspective,current status,and future considerations

Introduction: Percutaneous renal mass biopsy has evolved over the last decade with improvements on previous pitfalls including low tissue yield, high non-diagnostic rates, and complications. As understanding of tumor biology and natural history of renal cortical neoplasms has improved, percutaneous renal mass biopsy is poised to have an expanding role in an area characterized by individualized management and refined risk stratification.

Areas covered: This review summarizes the evolution of renal mass biopsy to its current state with respect to outcomes, indications, and clinical guidelines.

Expert opinion: With improved understanding of differential biological potential of renal cortical neoplasms combined with technical improvements in diagnostic yield and accuracy, utilization of renal mass biopsy is becoming an important adjunct to patient care in a broad range of clinical scenarios, including active surveillance, thermal ablation, and use of primary systemic therapy in localized and advanced settings.     

Linking the Disabilities of Arm, Shoulder, and Hand to the International Classification of Functioning, Disability, and Health.

The objective of this study was to explore whether the items from a specific outcome measure, that is, Disabilities of the Arm, Shoulder, and Hand (DASH), for quantifying limb symptoms and functions in musculoskeletal disorders fit into the framework of the International Classification of Functioning, Disability and Health (ICF). All DASH items were compared to the ICF according to eight linking rules. Two groups of researchers performed the linking independently, and the results were compared by correlation. The 30 DASH items and four items from the optional modules were linked to 63 ICF categories and 11 chapters: 15 categories belong to the ICF body functions component and 48 to the activities and participation component. There were no items coded under the components body structure or environmental factors. Kappa index showed an agreement of 0.73 (p<0.001). The results showed that the content of the DASH does link well with the ICF framework. Clinicians and researchers must attend to the fact that certain domains and categories from the ICF are not covered by the DASH. Limitations of the instrument may be overcome by simultaneously using other instruments that address the intended content.     

Quantitative assessment of callus distraction using dual energy X-ray absorptiometry

Summary. Bone mineralisation during and after limb lengthening procedures on the femur or tibia using unilateral fixators has been monitored quantitatively using dual energy X-ray absorptiometry (DEXA). We measured the bone mineral density (BMD) prospectively in the newly formed callus, in the bone adjacent to the callus and in the proximal femur. In twenty-one patients we showed a typical course with a peak value at 4 – 6 weeks after beginning distraction and a minimum value at maximum distraction. In the consolidation period the BMD in the distraction gap increased until the fixator was removed. The BMD in the regenerated bone increased faster in the regions of interest (ROI) opposite the fixator compared to those near it. Dynamisation caused more homogeneous regeneration equalising V _BMD in the different ROIs. The BMD in the proximal femur of the leg which was operated on decreased to 67% and in the opposite leg to 87% of the preoperative value. DEXA provides a precise and quantitative assessment of callus and bone mineralisation during limb lengthening and helps in understanding what is happening during these procedures.

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Résumé. Le processus de la minéralisation peut précisément être étudié d’une manière quantitative pendant et après la distraction du cal au moyen de l’absorptiométrie en énergie-binaire (DEXA) en créant une petite radioexposition. Des patients (n = 21) avec une distraction du cal, auxquels nous avons mesuré prospectivement la densité minérale de l’os (bone mineral density = BMD) dans et autour du cal nouvellement formé, étaient traités avec des fixateurs externes unilatéraux. La minéralisation a montré une courbe typique avec une première pointe de valeur [0,365 +/– 0,196 g/cm ² (30,9% de la première valeur)] à 4 – 6 semaines après le début de la distraction. Une valeur minimale apparut à la distraction maximale. Dans la période de consolidation la BMD est montèe jusqu’au moment de l’enlèvement du fixateur à 1,020 +/– 0,234 g/cm² (87%). La minéralisation du cal, mésurée grace à la technique des ?regions of interest (ROIs)?, augmenté plus vite aux ROIs éloignées qu’aux ROIs très proches du fixateur. De la dynamisation du fixateur résulte une vitesse de minéralisation plus homogène. Nous considérons la DEXA comme une méthode précise pour étudier les processus de la minéralisation et du développement du cal pendant la distraction avec un fixateur unilatéral. En tenant compte des limites de la technique, la DEXA – qui nous livre des valeurs quantitatives – nous aide à comprendre ce qui se passe pendant la distraction.

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Accepted: 11 July 1996     

Chemical resistance of the gram-negative bacteria to different sanitizers in a water purification system

Background  

Purified water for pharmaceutical purposes must be free of microbial contamination and pyrogens. Even with the additional sanitary and disinfecting treatments applied to the system (sequential operational stages), Pseudomonas aeruginosa, Pseudomonas fluorescens, Pseudomonas alcaligenes, Pseudomonas picketti, Flavobacterium aureum, Acinetobacter lowffi and Pseudomonas diminuta were isolated and identified from a thirteen-stage purification system. To evaluate the efficacy of the chemical agents used in the disinfecting process along with those used to adjust chemical characteristics of the system, over the identified bacteria, the kinetic parameter of killing time (D-value) necessary to inactivate 90% of the initial bioburden (decimal reduction time) was experimentally determined.     

Cross-cultural adaptation to Brazilian Portuguese of the Activity Measure for Post-Acute Care (AM-PAC) short forms for outpatients in rehabilitation

Background

The Activity Measure for Post-Acute Care was developed to evaluate the limitations of activities of adult individuals with different health conditions.