Modern CT applications in veterinary medicine.

Although computed tomography (CT) is used primarily for diagnosis in humans, it can also be used to diagnose disease in veterinary patients. CT and associated three-dimensional reconstruction have a role in diagnosis of a range of illnesses in a variety of animals. In a sea turtle with failure to thrive, CT showed a nodal mass in the chest, granulomas in the lungs, and a ball in the stomach. CT of a sea dragon with balance and movement problems showed absence of the swim bladder. In a sloth with failure to thrive, CT allowed diagnosis of a coin in the intestine. CT of a puffin with failure to thrive showed a mass in the chest, which was found to be a hematoma. In a smooth-sided toad whose head was tilted to one side and who was circling in that direction, CT showed partial destruction of the temporal bone. CT of a domestic cat with listlessness showed a mass with focal calcification, which proved to be a leiomyosarcoma. CT of a sea otter showed pectus excavatum, which is caused by the animal smashing oysters against its chest. In a Japanese koi with abdominal swelling, CT allowed diagnosis of a hepatoma.     

"Scrotal varicocele, exclude a renal tumour". Is this evidence based?

A scrotal varicocele is a common finding during both a scrotal clinical examination or during the course of a scrotal ultrasound examination and invariably found in the left hemiscrotum. Traditionally when a scrotal varicocele is found, the referring clinician requests a renal ultrasound examination or the sonographer extends the examination to include a renal examination; to exclude a retroperitoneal or renal tumour as the cause for the varicocele. The present article examines the relevance of performing the extended ultrasound examination by reviewing the pathophysiological pathways for the development of a varicocele in the presence of a renal or retroperitoneal tumour; the prevalance of co-existing renal or retroperitoneal tumours and a varicocele; and the male population in whom this extended examination may be necessary. The conclusion from available evidence suggests that a retroperitoneal tumour will manifest in other ways before the development of a varicocele, the young patient with a varicocele will almost never have a retroperitoneal tumour, and only when a varicocele develops in an older patient will an extended examination be relevant. Even then it will be a rare finding and there will be other clinical manifestations of the primary tumour.     

A 16-plex Y-SNP typing system based on allele-specific PCR for the genotyping of Chinese Y-chromosomal haplogroups

Y-chromosomal SNP (Y-SNP), with its stable inheritance and low mutation, can provide Supplementary information in forensic investigation. While commonly used Y-chromosomal STR haplotypes show their limitations, typing of Y-SNP would become a powerful complement. In this study, a 16-plex Y-SNP typing system based on allele-specific PCR (AS-PCR) was developed to discriminate four dominant Y-chromosomal haplogroups (C-M130, D-CTS3946, N-M231, and O-M175) and 12 predominant sub-haplogroups of O-M175 (O1a-M119, O1a1a1a-CTS3265, O1b-M268, O1b1a2-Page59, O2-M122, O2a1-L127.1, O2a1b-F240, O2a1b1a1-CTS5820, O2a2-P201, O2a2b1a1-M177, O2a2b1a1a1a-Y17728, O2a2b1a2-F114). A series of experimental validation studies including sensitivity, species specificity, male-female mixture and inhibition were performed. The discrimination of the typing system was preliminarily proved with a haplogroup diversity of 0.9239. Altogether, the Y-SNP typing system based on AS-PCR should be capable of distinguishing China’s dominant Y-chromosomal haplogroups in a rapid and reliable manner, thus can be employed as a useful complement in forensic casework.     

Mannosidosis: an unusual cause of a deforming arthropathy

We report on a case of a deforming arthropathy in a young man with a lysosomal storage disorder. A 31-year-old man with a known diagnosis of mannosidosis presented with a painful swollen right elbow. Radiographs of his right elbow showed a disorganised joint with multiple fragments resembling the appearances of a neuropathic joint. This case provides further evidence that a deforming arthropathy may occur as part of the spectrum of skeletal abnormalities seen in mannosidosis. Received: 17 November 1999 Revision requested: 13 December 1999 Revision received: 6 March 2000 Accepted: 9 March 2000     

The serum concentrations of TAG-72 antigen measured with CA 72-4 IRMA in patients with ovarian carcinoma. Preliminary data

The Authors assayed CA 125 (cut-off value: 65 and 35 U/ml), CA 19.9 (cut-off value: 40 U/ml) and CA 72.4 (cut-off value 3.8 U/ml) immunoreactivity in blood samples drawn before surgery in 34 patients with ovarian carcinoma and in 47 patients with benign ovarian pathology. With a cut-off value of 65 U/ml, CA 125 had a sensitivity (SE) for ovarian carcinoma of 85.3%, a specificity (SP) of 89.4%, a diagnostic accuracy (DA) of 87.7%; with a cut-off value of 35 U/ml CA 125 had a SE of 88.2%, a SP of 66.0%, a DA of 75.3%; CA 19.9 had a SE of 20.6%, a SP of 70.2%, a DA of 49.4%; CA 72.4 had a SE of 64.7%, a SP of 93.6%, a DA of 81.5%. CA 125 was expressed by all ovarian carcinoma histotypes. CA 72.4 seems to have a high correlation with mucinous histotype, analogously to CA 19.9. However CA 72.4 seems to be preferable to CA 19.9 for its greater sensitivity and specificity.     

Comparative evaluation of therapeutic efficacy of early amnion covering the cornea, temporary blepharorrhaphy and its combination in severe alkali burns of the eye in the experiment

In four groups of rabbits on model of a heavy alkaline burn of a cornea and a limbus of various extent character and outcomes of healing of an eye surface as a result of early (it is direct after a burn) applications is investigated: only conservative treatment - group I, conservative treatment + time blepharorrhaphy - group II, conservative treatment + covering of a cornea and a limbus of amnionic membrane - group III, and also combinations of conservative treatment, temporary of blepharorrhaphy and coverings of a cornea and a limbus amnionic membrane - group IV. In all groups conservative treatment included: an instillation of maxitrol within 14 days with transition to a mortgaging of Unguentum Tetracyclini of 1% 3 times a day. Depending on width of sector of the burn measured in circular degrees, each group included 4 subgroups: 60° - a subgroup "A", 120° " " - 180° - "B", 270° "Γ" - (on 4 eyes in a subgroup). Results estimated daily within the first 10 days, and further every 5 days (during 3 months) after a burn with photoregistration at colouring of an eye surface of 1% a solution fluorescein-natrium. On the basis of the received results it is established that the early fortnight time blepharorrhaphy (as addition to conservative treatment) is the most effective and accessible method (from considered) optimisation of healing of an eye surface at heavy burns of eyes with capture to 75% of the area of a cornea and a limbus.     

Abdominal aortic aneurysms: assessment with gadolinium-enhanced time-of-flight coronal MR angiography (MRA)

A prospective study was performed to evaluate the efficacy of a gadolinium-chelate-enhanced MR angiography (MRA) using a coronal acquisition in the preoperative assessment of aneurysms of the abdominal aorta (AAA). Twenty patients with AAA were explored with MR using a two-dimensional (2D) time-of-flight MRA technique with a coronal acquisition, before and after intravenous administration of 0.1 mmol/kg of a gadolinium-chelate. Gadolinium-chelate-enhanced MRA with a coronal acquisition decreased deleterious saturation effects within aorta and iliac arteries in 16 of 20 patients (80%) and improved the overall quality of the images of the upper and lower parts of the AAA (i.e. extent of the aneurysm). Furthermore, gadolinium-chelate-enhanced MRA with a coronal acquisition allowed a better differentiation between slow flow and mural thrombus. Gadolinium-chelateenhanced MRA had a sensitivity of 100% and a specificity of 96% for evaluation of renal artery involvement, and a sensitivity of 93% and a specificity of 100% for iliac artery involvement. The results of this study show that gadolinium-chelate-enhanced MRA obtained with a coronal acquisition is efficacious for the preoperative assessment of AAA.     

Integrated active tracking detector for MRI-guided interventions

We present a fully integrated detector suitable for active tracking of interventional devices in MR-guided interventions. The single-chip microsystem consists of a detection coil, a tuning capacitor, an intermediate frequency downconversion receiver, and a phase-locked-loop-based frequency synthesizer. Thanks to the integrated mixer, the chip output stage delivers an analog frequency-downconverted NMR signal in the frequency range from 0 to 200 kHz. The microchip, realized in a standard complementary metal oxide semiconductor technology, has a size of 1 × 2 × 0.74 mm(3) and operates at a frequency of 63 MHz (i.e., in 1.5 T clinical scanners). Tests in a standard clinical scanner demonstrate the compatibility of the complementary metal oxide semiconductor microchip with clinical MRI systems. Using a solid sample of cis-polyisoprene having a size of 1 × 1.9 × 0.8 mm(3) as internal signal source, the detector achieves a three-dimensional isotropic spatial resolution of 0.15 mm in a measuring time of 100 ms.     

Rendezvous technique following thermal ureteric injury after radiofrequency ablation in a solitary kidney

Percutaneous radiofrequency (RF) ablation is a promising treatment for solid renal tumors in selected patients. Nontarget thermal damage is a known risk of the procedure. The authors describe a case of a patient who underwent RF ablation of a lower pole renal lesion and subsequently developed a ureteric stricture secondary to thermal injury. Successful management of the ureteric stricture required a rendezvous procedure. This report illustrates the potential complication of ureteric stricture formation after a RF ablation procedure and the management challenges posed by such thermal injuries.     

Carotid-vertebrobasilar anastomosis

Anastomoses between carotid and vertebrobasilar vascular bed in extracranial region are less usual compensatory anastomoses of the brain vascular bed. They are either langer compensatory arteries--a. hypoglossica primitiva or a. proatlantica or smaller anastomoses between a. carotis externa and a. vertebralis. A precise differential diagnosis is difficult, as it requires selective catheterization of a. carotis externa, interna, a. vertebralis, or arcography. The paper demonstrates two cases. In a 75 years old man with symptoms of vertebrobasilar insufficiency there was a substantial filling of the whole vertebrobasilar vascular bed in puncture of a. carotis communis. In a 14 years old girl with coarctation of the aorta, acute hemiplegia and occlusion of a. carotis interna in supraclinoideal area there was a conspicuous abnormal filling of large veins in dorsal part of the neck and filling of the atlas loop of a. vertebralis. Selective catheterization could not be performed. The author is of the opinion that the case was an anastomosis between a. occipitalis and a. vertebralis.     

18F-FDG PET/CT findings of a right subphrenic foreign-body granuioma

We report a case of an 85-year-old woman with a foreign-body granuloma which accumulated 18F-fluorodeoxyglucose (FDG). Unenhanced computed tomography showed a hyperdense mass with a hypodense rim in the right subphrenic space. FDG PET/CT images showed intense FDG uptake in the hypodense rim and little FDG uptake in the center of the mass, showing a ring-shaped appearance. The fusion imaging of FDG PET/CT represented the metabolic features of the foreign-body granuloma. When a ring-shaped FDG uptake is noted in the abdomen of a patient with a history of abdominal surgery, a foreign-body granuloma should be included in the differential diagnosis.     

Pineal cystic germinoma with syncytiotrophoblastic giant cells mimicking MR imaging findings of a pineal cyst

We report a case of precocious puberty in a 4-year-old boy. Contrast-enhanced T1-weighted MR imaging suggested a pineal cyst with enhancement of the slightly thickened wall and focal wall irregularity. Three-dimensional constructive interference in a steady-state imaging revealed a focal lobulation and a nodule-like area in the lesion. The lesion mimicking a pineal cyst proved to be a germinoma with syncytiotrophoblastic giant cells, on the basis of biopsy and tumor marker results.     

Thyrotoxicosis: a rare presenting symptom of Hurthle cell carcinoma of the thyroid

Hurthle cell carcinoma of the thyroid is a rare type of thyroid neoplasm. The most common clinical presentation is a single palpable thyroid nodule. The neoplasm typically presents as a nonfunctioning or cold nodule on a Tc-99m sodium pertechnetate or radioiodine thyroid scan. We report a case of Hurthle cell carcinoma of the thyroid in a woman presenting with thyrotoxicosis. The Tc-99m thyroid scan was also interesting in that the nodule was a hot or hyperfunctioning area, resulting in a rare scintigraphic finding in a rare tumor. Clinicopathologic aspects and related issues are further discussed.     

Quantitative perfusion measurements using pulsed arterial spin labeling: effects of large region-of-interest analysis

PURPOSE: To study arterial spin labeling (ASL) MRI techniques and to investigate various problematic issues that still hinder the accurate and robust quantitative analysis of ASL data. MATERIALS AND METHODS: A pulsed-ASL (PASL) sequence was implemented on a 3-T imaging system and a protocol was developed for the measurement of perfusion based on fitting to a standard kinetic model. Both numerical simulations and multi-inversion time MRI data were analyzed. The effect of fitting a kinetic curve to a large region of interest (ROI) with a distribution of arterial transit times was compared to a pixel-by-pixel (PBP) method. RESULTS: It was found that a significant underestimation of perfusion of approximately 17+/-6% (P<0.001) occurs in gray matter, when comparing an ROI with a PBP analysis over a group of 12 healthy subjects. CONCLUSION: Analysis of ASL data based on a large ROI may suffer from inaccuracies arising from a distribution of transit times, implying that averaging of ASL kinetic data over such regions should therefore be avoided. When possible, a PBP fit should be performed.     

Alveolar soft part sarcoma of the retroperitoneum: A case report

Alveolar soft part sarcoma is a rare soft tissue tumor with uncertain histogenesis. It is a slow growing tumor with a high rate of metastasis. The tumor is not easily identified as clinical symptoms are not pronounced. The retroperitoneum is a rare location of tumor, with a few cases published in literature. Surgical excision is the mainstay of treatment. Here we describe a rare case of a large retroperitoneal Alveolar soft part sarcoma in a young female with radiological and histopathological findings.     

Endocrine aspects of high altitude acclimatization and acute mountain sickness

The acute acclimatization to high altitude is underpinned by a diuresis (and to a lesser extent a natriuresis) that facilitates a reduction in plasma volume. This allows a haemoconcentration to occur that increases the oxygen carrying capacity of a given volume of blood, a vital effect in the presence of a reduced partial pressure of oxygen. This critical acclimatization process is orchestrated by the endocrine system. This review will present the key evidence regarding the changes in several important hormones that affect this process.     

Huge renal lipoma with prominent hypervascular non-adipose elements

A primary renal lipoma is a very rare neoplasm of the kidney and only 20 cases have been reported in the literature. We report a case of a huge retroperitoneal mass that presented as a hypervascular tumour with a prominent fat component, mimicking an angiomyolipoma or a liposarcoma in imaging studies. This finding presented a diagnostic challenge in terms of selecting medical versus surgical intervention. Surgical excision of the lesions was performed and the pathological evaluation revealed a renal lipoma with extrarenal growth.     

A technique to circumvent subcutaneous cement tracts during percutaneous vertebroplasty

The deposition of a subcutaneous cement tract is a potential complication of percutaneous vertebroplasty. These tracts can be a source of pain and tenderness for the patient. We describe a case of symptomatic cement deposition within a needle tract in the subcutaneous tissues that required surgical removal, and we describe a technique to prevent this complication in a second patient, by using needle redirection to cut across the cement core.     

Arteriographic findings in a Schipper's fracture at the shaft of the femur (author's transl)]

This report on a Schipper's fracture at the shaft of the femur in a twelve-year old boy is preceded by a systematic tabulation of the various non-traumatic types of fracture and a general synopsis of stress fractures. At the time of a first exacerbation of pain which had been persisting for several weeks, the x-ray film showed periostal callus formation and a discrete, transverse zone of increased density. Four weeks later, this zone had widened, the central region showing a fine, tape-like translucence. The arteriogram showed a local increase in the number of vessels in the vicinity of the stress fracture.     

A thyroid nodule representing metastatic renal carcinoma

Metastatic neoplasms to the thyroid that become clinically apparent are rare, but a patient that presents with a thyroid nodule and a history of a prior malignancy elsewhere (especially a renal neoplasm) should be thought to have a metastatic nodule first and a nodule of thyroid origin second. This report describes a 66-year-old woman who presented with a large symptomatic thyroid nodule and a history of a right nephrectomy for renal carcinoma two years previously.