Magnetization transfer: a potential method to determine the age of multiple sclerosis lesions.

PURPOSETo determine whether magnetization transfer contrast can differentiate acute from chronic lesions in multiple sclerosis.METHODSThirteen patients with multiple sclerosis and eight healthy patients were studied with MR using a 0.1-T system. Relatively T2-weighted spin-echo images were obtained without and with magnetization transfer contrast. The magnetization transfer effect of multiple sclerosis lesions was calculated and compared with the ages of the lesions. The magnetization transfer effect of normal-appearing white matter in patients with multiple sclerosis was calculated and compared with the magnetization transfer effect of white matter in healthy volunteers. Statistical analysis was performed.RESULTSWhite matter in the healthy volunteers had values from 0.40 to 0.45. Normal-appearing white matter in the patients with multiple sclerosis had magnetization transfer effect values ranging from 0.41 to 0.45. Multiple sclerosis plaques of less than 1 year''s duration had magnetization transfer effect values ranging from 0.05 to 0.26; older plaques had values from 0.25 to 0.41. The difference in the distributions of these values for acute and chronic multiple sclerosis plaques is statistically significant.CONCLUSIONCurrent imaging modalities do not differentiate acute multiple sclerosis lesions from chronic ones. Our data on magnetization transfer show a statistically significant difference in magnetization transfer effect values between lesions of less than 1 year''s duration and older lesions. The different values may correspond to the histologic changes of multiple sclerosis plaques over time. Magnetization transfer may be a reliable method for determining the age of multiple sclerosis lesions.     

Evaluation of 11C-choline PET/CT for primary diagnosis and staging of urothelial carcinoma of the upper urinary tract: a pilot study

Purpose

We conducted a pilot study to prospectively evaluate the efficacy of PET/CT with ¹¹C-choline (choline PET/CT) for primary diagnosis and staging of urothelial carcinoma of the upper urinary tract (UUT-UC).

Methods

Enrolled in this study were 16 patients (9 men, 7 women; age range 51 – 83 years, mean?±?SD 69?±?10.8 years) with suspected UUT-UC. The patients were examined by choline PET/CT, and 13 underwent laparoscopic nephroureterectomy and partial cystectomy. Lymphadenectomy and chemotherapy were also performed as necessary in some of the patients. Of the 16 patients, 12 were confirmed to have UUT-UC (7 renal pelvis carcinoma and 5 ureteral carcinoma), 1 had malignant lymphoma (ureter), 1 had IgG4-related disease (ureter), and 2 had other benign diseases (ureter).

Results

Of the 16 study patients, 13 showed definite choline uptake in urothelial lesions, and of these, 11 had UUT-UC, 1 had malignant lymphoma, and 1 had IgG4-related disease. Three patients without choline uptake comprised one with UUT-UC and two with benign diseases. Of the 12 patients with UUT-UC, 3 had distant metastases, 2 had metastases only in the regional lymph nodes, and 7 had no metastases. Distant metastases and metastases in the regional lymph nodes showed definite choline uptake. The outcome in patients with UUT-UC, which was evaluated 592 – 1,530 days after surgery, corresponded to the patient classification based on the presence or absence of metastases and locoregional or distant metastases. Choline uptake determined as SUVmax 10 min after administration was significantly higher than at 20 min in metastatic tumours of UUT-UC (p?Conclusion This study suggests that choline PET/CT is a promising tool for the primary diagnosis and staging of UUT-UC.     

High Grade Hemangioendothelioma of the Temporal Bone in a Child: A Case Report

Hemangioendothelioma is a rare vascular tumor characterized by endothelial tumor cells and variable malignant behavior, and it''s not common for this lesion to involve the bone. Although there are a few reports of cranial involvement by hemangioendothelioma, only rare cases arising in temporal bone have been published. We present the radiologic findings of a 7-year-old boy who had a high grade hemangioendothelioma involving the temporal bone with intracranial extension. Evidence of flow voids on MR images suggested a tumor of vascular origin, and the ill-defined margins, cortical destruction and intracranial extension on the CT and MR images were correlated with the tumor''s high histologic grade.     

Soft Foods for a Sore Mouth

After weight lifting, a 15-year-old boy pain in his right wrist, had tenderness over the dorsum of the lunate, and had limited wrist motion. Radiographs revealed avascular necrosis of the lunate, or Kienböck's disease, and negative ulnar variance. The patient was successfully treated with an ulnar lengthening procedure and immobilization. This patient's symptoms are typical of Kienböck's disease, which should be considered in the differential diagnosis of any active patient who has wrist pain and limited wrist motion. Treatment of this rare disorder can include immobilization for early-stage disease, or surgery, which is most likely to provide an optimal outcome.     

Cyberknife stereotactic radiosurgery for the re-irradiation of brain lesions: a single-centre experience

Purpose

The aim of our study was to retrospectively evaluate the feasibility and clinical benefit of cyberknife stereotactic radiosurgery (CSRS) in patients treated at Florence University for recurrent, pre-irradiated brain lesions.

Materials and methods

Thirteen patients were retreated with cyberknife. Mean age was 47.1 years (range 33–77 years). Karnofsky performance status ranged from 60 to 100 (median 80). Eleven (84.6 %) out of 13 patients had metastatic lesions: four (36.4 %) had primary lung, three (27.2 %) had primary breast cancer and four (36.4 %) other types of solid malignancies. Two (15.4 %) out of 13 patients had recurrent of glioblastoma.

Results

In terms of compliance with CSRS, the majority of patients did not develop any acute side effects. However, two (15.4 %) out of 13 patients developed acute grade 2 toxicity requiring an increase of steroid medication. At the time of the last follow-up, response rates were as follows: complete response in one case (16.6 %), partial response in three (50 %) and stable disease in two (33.4 %).

Conclusions

Re-irradiation with CSRS is a feasible and effective option for pre-irradiated, recurrent brain lesions to obtain clinical benefit without excessive acute toxicity.     

Death of a child following a superstitious ritual of exorcism

IntroductionDiseases, especially those related to the psyche produced by demons, are an accepted belief in many communities. This paper elaborates on the death of a child, a victim of an exorcism ritual, and calls for adequate awareness and preventive measures.Case reportThe deceased, a 9-year-old child, was taken by her mother to an exorcist to 'expel a demon from her body. The exorcist caned the child for two days while giving 'water' to drink. On the ^second day, the child lost consciousness and was pronounced dead on admission. On direct questioning, it was revealed that the child had been made to consume some medicinal syrups forcefully by the mother and the exorcist. The autopsy revealed multiple abrasions, tram-line contusions and burns on the body. There was mottling and consolidation in the lungs. Blood-stained secretions were found in the trachea, bronchi, and stomach. Musculoskeletal dissection revealed subcutaneous haemorrhages and muscular contusions over the buttocks and limbs. Histology revealed evidence of well-established aspiration pneumonia. There was no other significant pathology, especially no evidence of acute kidney injury due to rhabdomyolysis. Toxicological analysis was negative for common poisons, therapeutic drugs, and heavy metals. The cause of death was concluded as aspiration pneumonia in a child subjected to physical violence.ConclusionWith the forceful feeding of the syrup, the child can have aspiration, resulting in aspiration pneumonia. At the same time, it appears that even after the child became symptomatic, she had not been brought for medical treatment but had continued with the same exorcistic therapy. While the caregivers become responsible for the child's death, the lessons to be learnt are enormous. Thus, banning such practices against children is a need of the hour.     

Light microscopy can reveal the consumption of a mixture of psychotropic plant and fungal material in suspicious death

Light microscopical examination of plant and fungal remains in the post mortem gut may be capable of demonstrating the ingestion of unexpected natural psychotropic materials. This is demonstrated here in a case in which a 'shaman' was accused of causing the death of a young man. The deceased had participated in a ceremony which involved the drinking of ayahuasca in order to induce a psychotropic experience. Ayahuasca is an infusion of Banisteriopsis caapi (ayahuasca vine), which produces a monoamine oxidase inhibitor, and one or more additional tropical plants, generally Psychotria viridis (chacruna) which produces dimethyltryptamine (DMT). The monoamine oxidase inhibitor prevents DMT from being broken down in the gut, so enabling its passage into the bloodstream and across the blood/brain barrier. Toxicological tests for DMT demonstrated the presence of this compound in the body. The deceased was reported to be in the habit of using Psilocybe semilanceata (liberty cap). This fungus (popularly called magic mushroom) contains psilocybin which is hydrolysed in the gut to psilocin; this compound mimics a serotonin uptake inhibitor, and also invokes psychotropic experiences. Microscopical examination established that the ileum and colon contained spores of Psilocybe and, in addition, pollen of Cannabis sativa and seeds of Papaver cf. somniferum (opium poppy). Both the plant species yield psychotropic substances. Palynological and mycological analysis of containers from the deceased person's dwelling also yielded abundant trace evidence of pertinent pollen and spores. The police had requested analysis for DMT but there was no screening for other psychotropic substances. Investigators were surprised that a mixture of hallucinogenic materials had been consumed by the deceased. The charge was modified from manslaughter to possession of a ‘Class A’ drug as the deceased had been consuming psychotropic substances not administered by the 'shaman'. Where death involving drugs from plants or fungi is suspected, microscopical examination of samples from the gut can provide a rapid and effective method for assessing, in a temporal context, the presence of ingested materials that may not have been previously suspected. The example presented here also demonstrates the need for caution in interpreting toxicological results where screening for unusual compounds has been limited.     

Sudden death in a child caused by a giant cavernous hemangioma of the anterior mediastinum

A 4-year-old girl who had been treated for asthma since the age of 2 years had a severe coughing fit and died suddenly. The patient had a history of occasional severe coughing fits, and these fits had been worsening in severity during the week before her death. Prior to death, she was taken to a clinician, and thymic hypertrophy was suspected based on chest X-ray findings. The clinician recommended that she visit a general hospital at a later date; however, she died that night. Postmortem radiology and autopsy revealed a large mass in the anterior mediastinum compressing the heart and airway, and no other findings attributable to sudden death were observed. Therefore, we concluded that the patient's death was attributable to acute respiratory and cardiac circulatory failure secondary to the pressure induced by the mass. Microscopically, the mass showed a cavernous structure composed of cystically dilated, thin-walled large vessels filled with blood. The final diagnosis was a cavernous hemangioma. Hemangiomas are the most common benign vascular anomalies seen in young children; however, mediastinal hemangiomas are rare and can cause life-threatening complications because of their size and location. Therefore, forensic pathologists should include hemangioma as a differential diagnosis in children with anterior mediastinal masses.     

Understanding the role parents play in tennis success: a national survey of junior tennis coaches

Objectives

To assess coaches'' perceptions about the role of parents and their positive and negative behaviours in junior tennis.

Methods

A national survey of 132 United States junior tennis coaches was completed. The extent and seriousness/impact of parent‐child interaction problems and positive behaviours were rated.

Results

Parents were perceived as very important for junior tennis success. Most parents (59%) that these coaches had worked with were seen as having a positive influence on their player''s development. However, the respondents also felt that 36% of parents negatively influenced their child''s development. Positive parental behaviours included providing logistical, financial, and social‐emotional support, as well as tennis opportunities and unconditional love. Negative parent behaviours included overemphasising winning, holding unrealistic expectations, and criticising their child.

Conclusions

Findings are discussed relative to current sport parenting and athletic talent development research and theorising. The need to educate parents is emphasised.     

Diagnostic radiography students' perceptions of formative peer assessment within a radiographic technique module

IntroductionAssessment is a central part of student learning. Student involvement in peer assessment leads to significant improvement in students' performance, supports students' learning, promotes the development of evaluation skills and encourages reflection.AimThe aim of this study is to assess perceptions of the Formative Peer Assessment (FPA) initiative within a higher education setting for undergraduate radiography students.MethodsQualitative action research was conducted. Students were allowed to anonymously assess each other's assignments using a standardized evaluation sheet that they had been trained to use. Participants' perceptions were assessed through focus group discussion.ResultsThe findings showed that students' experiences with peer assessment were positive. Students acknowledged that they received valuable feedback and learned from assessing their peers. Students recommended the need for training and suggested using more than one evaluator.ConclusionThe FPA initiative in the study institution believed to be succeed as the students had a positive experience with the FPA. Students learnt from PA and from self-assessment. Implementation of PA will promote reflection and critical thinking and problem solving skills, that are important traits in radiography graduate profile as in radiography clinical practice the professional require to modify imaging techniques and critique images to ensure the quality of care.     

Impact of a CAD system in a screen-film mammography screening program: A prospective study

ObjectiveThe purpose of our study was to perform a prospective assessment of the impact of a CAD system in a screen-film mammography screening program during a period of 3 years.Materials and methodsOur study was carried out on a population of 21,855 asymptomatic women (45–65 years). Mammograms were processed in a CAD system and independently interpreted by one of six radiologists.We analyzed the following parameters: sensitivity of radiologist's interpretation (without and with CAD), detection increase, recall rate and positive predictive value of biopsy, CAD's marks, radiologist's false negatives and comparative analysis of carcinomas detected and non-detected by CAD.ResultsDetection rate was 4.3‰. CAD supposed an increase of 0.1‰ in detection rate and 1% in the total number of cases (p < 0.005). The impact on recall rate was not significant (0.4%) and PPV of percutaneous biopsy was unchanged by CAD (20.23%). CAD's marks were 2.7 per case and 0.7 per view. Radiologist's false negatives were 13 lesions which were initially considered as CAD's false positives.ConclusionsCAD supposed a significant increase in detection, without modifications in recall rates and PPV of biopsy. However, better results could have been achieved if radiologists had considered actionable those cases marked by CAD but initially misinterpreted.     

Evaluation of radiographic abnormalities of the hand in patients with the Mayer-Rokitansky-Küster-Hauser syndrome

Radiographs of the hand in a group of 40 patients with the Mayer-Rokitansky-Küster-Hauser (MRKH) syndrome were studied. Most of the patients had the following abnormalities: brachymesophalangy of digits 2–5 (22/39 patients), small distal phalanx of digit 1 (22/39 patients), long proximal phalanx of digits 3–4 (19/39 patients), and long metacarpals of digits 1–4 (20/39 patients). In addition, three patients had distinct radial dysplasia and abnormalities of the carpals.     

Non-self DNA on the neck: a 24 hours time-course study

Non-self DNA is normally present on skin due to DNA transfer occurring during daily activities. The understanding of persistence and accumulation of foreign DNA on the neck can assist in the interpretation of DNA evidence collected from an assaulted victim. Establishing the composition and level of non-self DNA present is relevant, especially in cases where the victim cohabits with other individuals, such as partner and children. This study investigated the persistence and accumulation of non-self DNA on the neck, over the course of 24 h. DNA samples were collected from the neck of 20 adult volunteers at three time-points, on two days. The detection of a partner's DNA and DNA from unknown sources was studied in relation to the living arrangement and to the activities performed by each individual. An increased number of non-self alleles were detected over time. Partner's DNA was observed to accumulate during the day and to persist when an individual was absent from the shared home environment. DNA from unknown contributors was found on the neck of individuals that used public transport, attended public spaces and had social interactions. The data acquired from this study will help to increase knowledge on the composition of DNA present on an individual's neck in a daily situation.     

A rare case of COVID-19 vaccine-induced myopericarditis in a young adult

Although extremely rare, the COVID-19 mRNA vaccine can induce myopericarditis without left ventricular dysfunction, and there have been rare reports of such incidents. However, these prior cases either did not have pericardial effusion without reduced left ventricular ejection fraction or had a more typical presentation of vaccine-induced myopericarditis such as shortness of breath or tactile temperature. We present a rare case of a 25-year-old man who developed myopericarditis following administration of the second dose of COVID-19 mRNA Vaccine. As vaccination plays a significant role in the fight against the COVID-19 pandemic, it is essential to highlight the physical manifestations of the vaccine''s potential adverse effects and risk factors to increase the general population''s awareness regarding the importance of emergent medical care.Kewyords: COVID-19, Myopericarditis, Pericardial effusion, Vaccine, Myocarditis, Pericarditis     

Simultaneous presentation of subcortical hemorrhage,subdural hemorrhage,and cerebral infarct in a hemiplegic patient

A 90-year-old, non-hypertensive woman presented gait disturbance followed by falls. She had developed a lacunar infarction in the right frontal lobe 1 month previously that subsequently resulted in subtle motor weakness in the left lower extremity. At presentation, the patient showed motor weakness in the left upper and lower extremities with normal findings on blood test. Cranial computed tomography (CT) revealed a subcortical hemorrhage in the anterior part of the right frontal lobe that was accompanied by perilesional edema. In addition, two small subdural hematomas, apparently in the acute phase, were found. Magnetic resonance imaging performed immediately after the CT revealed hyperacute infarct in the right precentral gyrus adjacent to the previous infarct. It was hyperintense on the diffusion-weighted imaging but indistinct on the fluid-attenuated inversion recovery sequence. In addition, findings suggesting cerebral contusions were not observed. Based on these, we assumed that the patient''s symptoms were mainly derived from the infarct and the subdural hemorrhages had developed in association with falls. However, it was unclear whether the infarct had developed before or after the formation of subcortical hemorrhage. Traumatic and non-traumatic intracranial hemorrhage and cerebral infarcts may present simultaneously. When intracranial hemorrhages appearing on CT do not adequately explain the patient''s neurological findings, undetected cerebral ischemia should be assumed.     

Parents' experiences of having their children take part in participatory action research creating a serious game about radiotherapy

IntroductionRadiotherapy (RT) is one of several treatment modalities used for children diagnosed with cancer. Several studies have designed interventions aimed to alleviate the stress that can occur in conjunction with RT. To include children in the design of interventions is rare and dependent on the parents giving consent to participation in research on their children's behalf. The aim was to illuminate, from the parents' perspective, the experience of their children being part in the co-creation of a serious game and their previous experiences of RT.MethodsTen parents of children taking part in a participatory action research study of the development of a serious game were invited to an interview and seven parents consented. An inductive, manifest content analysis was performed.ResultsThe analysis resulted in an overarching theme: Parents' pre-understanding from their child's cancer treatment created a sensitivity to their child's wishes and a willingness to contribute to science. Four categories are presented: Intrinsic factors influenced the intent to participate, Extrinsic factors that had an effect on participation, Parents role in the game development, and Radiotherapy impinged the child and the parent.ConclusionTo be able to pay it forward to healthcare and other families with a child diagnosed with cancer was a contributing factor for parents' willingness to consent to participation after their children had undergone RT, especially since their children wanted to do so. Parents indicated interest in the developmental process and in following their children being part of the creation of a serious game about RT.Implication for practiceTo understand why parents allow their children to participate in studies creates opportunities for the research community to structure studies that facilitate participation.     

Paternity testing that involves a DNA mixture

Here we analyse a complex disputed paternity case, where the DNA of the putative father was extracted from his corpse that had been inhumed for over 20 years. This DNA was contaminated and appears to be a mixture of at least two individuals. Furthermore, the mother's DNA was not available. The DNA mixture was analysed so as to predict the most probable genotypes of each contributor. The major contributor's profile was then used to compute the likelihood ratio for paternity. We also show how to take into account a dropout allele and the possibility of mutation in paternity testing.     

Pseudoangiomatous stromal hyperplasia in a healthy young adult male

This case report describes the occurrence of a rapidly enlarging pseudoangiomatous stromal hyperplasia (PASH) tumor in a 20-year-old male patient. The diagnosis was made via tomosynthesis and ultrasound-guided biopsy with pathological correlation consistent with PASH. The patient''s case was discussed, and he was recommended to undergo surgical resection of the mass to alleviate symptoms due to its large size. Surgical pathology confirmed the original diagnosis and the patient had an uncomplicated postoperative course. Here, we exhibit our imaging findings; review classic presentations of PASH on mammography, ultrasound, and MRI; and discuss histological characteristics of this benign entity.     

A New Technique for Superselective Catheterization of Arteries: Preshaping of a Micro-Guide Wire into a Shepherd's Hook Form

Objective

We wanted to introduce a new technique for superselective catheterization of arteries with preshaping of a micro-guide wire into a shepherd''s hook form, and this is useful for superselection of small arteries branching at an acute angle from a large parent artery for the treatment of tumors and hemorrhages.

Materials and Methods

We developed a superselective catheterization technique by using preshaping of a micro-guide wire into a shepherd''s hook form. We encountered six patients in our practice for whom we failed to catheterize the small tumor-feeding arteries that branched at an acute angle from wide parent arteries during chemoembolization of hepatocellular carcinoma; the parent arteries were the right inferior phrenic artery (n = 4) and the left gastric artery (n = 1) from the celiac axis with celiac stenosis due to compression by the median arcuate ligament and the proper hepatic artery from the gastroduodenal artery (n = 1) in a patient who had celiac axis occlusion with collateral circulation via the pancreaticoduodenal arcade from the superior mesenteric artery. In these consecutive six patients, we tested the usefulness of this new technique with employing preshaping of a micro-guide wire into a shepherd''s hook form for superselective catheterization of targeted vessels.

Results

The target arteries were successfully catheterized and satisfactory transcatheter arterial chemoembolization was performed in all six patients. There were no significant complications such as arterial dissection.

Conclusion

We developed a technique that is effective for superselection of vessels with preshaping of micro-guide wire into a shepherd''s hook form, and we successfully applied it during chemoembolization of hepatocellular carcinoma. This technique can be useful for superselection of small arteries that branch from a large parent artery at acute angles for the treatment of tumors and hemorrhages.     

Relation of early post-stress left ventricular dyssynchrony and the extent of angiographic coronary artery disease

Background

Previous studies showed different dyssynchrony patterns between ischemic and normal myocardium at early post-stress using Tl-201 gated SPECT myocardial perfusion imaging (MPI). The aim of this study was to assess the relation of stress-induced dyssynchrony and the extent of angiographic coronary artery disease (CAD).

Methods and Results

The MPI images of 144 patients were retrospectively analyzed. With ≥70% stenosis as the criteria of CAD, 57 had no CAD, 32 had 1-vessel disease, 36 had 2-vessel disease, and 19 had 3-vessel disease, respectively. LV global and territorial dyssynchrony parameters were measured by the phase analysis from stress/rest Tl-201 SPECT MPI and compared between stress and rest among the patient groups. The patients with multi-vessel CAD had significantly more global dyssynchrony than the patients without ≥70% stenosis at stress. The patients with multi-vessel CAD showed significantly more global and territorial dyssynchrony on stress images than on rest. More patients with 3-vessel CAD were correctly classified as multi-vessel disease, when combining both visual interpretation and dyssynchrony assessment.

Conclusion

The patients with multi-vessel CAD had significantly more global and territorial dyssynchrony at early post-stress than at rest. Such quantitative measures of myocardial stunning may assist in the diagnosis of multi-vessel CAD.