"Lights and shadows" in ultrasonography

The case of a 40-year-old male patient come to the emergency service with symptoms suspicious of biliary colic, is presented. Liver sonography was requested to evaluate the parenchyma, the gallbladder and bile duct caliber in the suspicion of lithiasis. During the examination a hyper-reflecting image with posterior shadowing was detected at the level of the gallbladder infundibulum. However, the shadowing was not typical of lithiasis. This aroused some doubts and the scan was repeated after some minutes: an absolutely normal infundibulum was visualized. The shadowing was therefore an artifact probably due to a partial volume effect of the air contained in the distended duodenum, in contact with the gallbladder. The formation process of the sonographic image is carefully analyzed with particular reference to the situations generating artifacts.     

"Interventional radiology" in breast examination

The data on such highly-effective invasive diagnostico-therapeutic procedures as ductography, sclerosing-solution cystography, X-ray-controled puncture biopsy, stereotactical computer technique, sonography and preoperative maging of nonpalpable lesions were analyzed following a complex mammographic examination of 20,000 patients with different breast pathologies. Advantages offered by complex breast examination are discussed. Among them were the use of optimal effects of each invasive procedure, an accuracy of preoperative diagnosis reaching 95-98% (nonpalpable breast lesions included) and a significantly reduced extent of breast surgery.     

Correlation between differentiation and malignancy in human malignant melanocytes "in vivo" and "in vitro" (author's transl)]

The relationships between differentiation and malignant transformation were studied in human malignant melanomas in vivo and in vitro. Melanocyte differentiation was assessed by ultrastructural morphological characteristis (the appearance of the melanosomes and related structures) localization of dopa-oxidase and assay of 5-S-cysteinyldopa, a specific metabolite. The transformed characteristic of the cells in vitro was evaluated by their ability to give rise to established cell lines, karyological modifications and heterotransplantation in Nude mice and Syrian hamsters. Morphological variability of the cells in malignant melanomas is accompanied by variability in the localization of dopa-oxidase, the level of 5-S-cysteinyldopa, chromosome pattern and their heterotransplantibility. The lack of pigmentation in some malignant melanoma lines can result from either an irreversible loss of some functions which give rise in melanization and the malignancy in maintained, or by phenomenon of regulation determined by intra or extra-cellular factors with the loss of heterotransplantability. Modulation phenomena affecting tumorigenicity and pigmentation although sometimes concomitant are not identical.     

Telomerase activity in "suspicious" thyroid cytology

BACKGROUND: Telomerase activity (TA) has been detected in most malignant neoplasms, including thyroid carcinomas. The authors studied the utility of TA detection as an ancillary tool to thyroid fine-needle aspiration (FNA) for patients with nonconclusive cytologic diagnoses. METHODS: Material obtained by FNA from palpable thyroid nodules in 167 consecutive patients was processed for conventional cytologic studies and simultaneously for TA study. Another 8 patients were excluded from TA because of the presence of lymphocytes. All patients with negative results cases were followed for > 1 year, and those who had tumors that were suspicious or positive by FNA or TA underwent resection for pathologic study of nodules. TA was analyzed by telomere repeat amplification protocol-polymerase chain reaction analysis. RESULTS: After excluding 20 patients because of insufficient material for cytologic study, 120 patients had negative results for malignant cells in cytology material, and the remaining 27 patients had results that were either suspicious (n = 21 patients) or positive (n = 6 patients). Histopathologic confirmation was obtained in 23 patients, including 18 with suspicious cytology (1 with scanty material) and 5 with positive FNA. The histopathologic diagnoses were nodular hyperplasia in 5 patients, follicular adenoma in 3 patients, papillary carcinoma in 11 patients, follicular carcinoma in 1 patient, medullary carcinoma in 2 patients, and lymphoma in 1 patient. TA was detected in 6 of 18 histologically confirmed thyroid neoplasms (1 of 3 follicular adenomas, 3 of 11 papillary carcinomas, 0 of 1 follicular carcinoma, 1 of 2 medullary carcinomas, and 1 of 1 lymphoma), including 1 neoplasm with scanty atypical cells. CONCLUSIONS: The detection of TA helped to confirm neoplasia in 6 of 23 suspicious thyroid nodules. Although it was less sensitive than FNA, TA specificity was 100% for neoplasia and 87.5% for malignancy. The sensitivity of thyroid FNA increased with the use of TA detection when cytology was nonconclusive for malignancy.     

Results of transcutaneous nephrolithotripsy using the combined lithotriptor "2 in 1" "Swiss Lithoclast Master"

The aim of the study was to determine frequency of infectious-inflammatory complications regarding the duration of transcutaneous nephrolithotripsy (TCNL). Two groups of nephrolithiasis patients were compared. Group 1 consisted of 37 nephrolithiasis patients aged 20 to 78 years (15 males, 22 females). Size of the concrements ranged from 1.8 to 4.9 cm. They underwent contact lithotripsy performed by an ultrasound lithotriptor. Group 2 consisted of 22 patients aged 34 to 74 years (11 males and 11 females). Nephroliths were 2.0 to 8.5 cm in size. Group 2 patients underwent combined contact pneumatic and ultrasound lithotripsy on a novel Swiss LithoClast Master unit. Elimination of the nephroliths was observed in 27 (72.9%) patients of group 2 and in 19 (86.3%) patients of group 2. Residual calculi were detected in 10 (27%) patients of group 1. Surgery lasted 66 to 140 min (mean 81.2) and 40 to 120 min (mean 58.5 min) in groups 1 and 2, respectively. Pyelonephritis activity was registered in 24 (77.4%) and 3 (13.6%) patients, respectively. Thus, in percutaneous lithotripsy of large stones, frequency of inflammatory complications depends not only on technical faults and initial bacteriuria, but also on the duration of the operation. If surgical intervention took more than 60 min, frequency of the infectious-inflammatory complications increased 1.6-fold. Utilization of the lithotriptor Swiss LithoClast Master raises efficiency, accelerates destruction and evacuation of stones.     

Reproducibility of results in "near-replicate" carcinogenesis bioassays

Reproducibility of results was examined in 70 "near-replicate" comparisons consisting of 2 or more long-term carcinogenesis bioassays of the same chemical administered by the same route and using the same sex and strain of rodent. Overall, there was good reproducibility of positivity, target site, and carcinogenic potency in hamsters, mice, and rats. The published authors' opinions about whether the test was positive disagreed in only 9 of the 70 comparisons. Among the 35 comparisons in which all tests of the chemical were positive, 33 of the near-replicates had at least 1 identical target site. The carcinogenic potency values estimated from near-replicate tests in these 35 comparisons were within a factor of 2 of each other in 40% of the comparisons, within a factor of 5 in 80%, and within a factor of 10 in 90%. For the few cases in which the carcinogenic response was not reproduced, analyses suggest two explanations: In mice the discrepant cases tended to have shorter experiment times than average; in both rats and mice the discrepant results tended to be tests of weakly active compounds.     

International trends in prostate-cancer mortality in the "PSA ERA"

Incidence and mortality from prostate cancer were rising in most countries until the late 1980s. Following a number of advances in the management of prostate cancer, including introduction of the prostate-specific antigen (PSA) test, there have been reports of declines in mortality in Canada, the United States and the United Kingdom. To investigate the extent to which this pattern was seen in other industrialised countries, we used routinely collected data to explore recent changes in prostate-cancer mortality. Trends in age-standardised death rates between 1979 and 1997 for men aged 50 to 79 years in 24 industrialised countries were compared using join point regression. Join point regression allows estimation of the annual percentage change in death rates and tests for significant changes in trend. During the period studied, age-standardised mortality increased at 1% to 2% per year in most countries. In 7 countries (Canada, United States, Austria, France, Germany, Italy and United Kingdom), a significant down-turn in age-standardised mortality was observed over the period 1988-1991. Trends in age-specific rates within these countries support a period effect on prostate-cancer mortality. Declines in mortality could result from any combination of either artefact, reduction in prostate-cancer incidence, a rise in competing causes of death or changes in the risk of death from prostate cancer. There are inconsistencies in the relationship between national mortality trends and uptake of PSA screening; further research is required to determine whether changes in death rates can be explained by international and secular variations in the treatment of prostate cancer.