Radial scar: from conventional imaging to the new techniques. Case reports

The role of MR-mammography in radial scar was assessed in 4 female patients. All 4 patients showed mammographic findings of radial scar and underwent dynamic MR-mammography. MR-mammographic findings were compared with histopathological results. On MR-mammography a focal enhancing lesion with irregular margins, plateau or rapid wash-out time/signal intensity curves, with maximum signal intensity > 100% were documented in the 4 patients. The histological diagnosis identified i case of infiltrating lobular carcinoma, 1 case of atypical hyperplasia and 2 cases of typical hyperplasia. In the preliminary study, MR-mammography was superior to mammography in the assessment of the extent and margins of the lesions. However, in the 4 study patients it could not accurately differentiate between carcinoma and benign lesions. It should be observed that lesions suggestive of radial scar have to be removed by surgery.     

Megaureter and ureteral valves

Primary megaureter is visualized as a typical dilatation on urography. Adequate oblique projections should be added to depict the juxtavesical tract of normal caliber. In even the most severe forms pyelocaliectasis is absent or mild and the ureter is not tortuous. Sonography as well as fluoroscopy during urography shows hyperperistalsis in the dilated tract and aperistalsis in the juxtavesical tract. Cystography rules out vesicoureteral reflux. In prune-belly syndrome the megaureter is bilateral and massive with no evidence of obstructions. The sonographic finding of hydronephrosis or hydroureteronephrosis and the absence of vesicoureteral reflux on voiding cystography lead to the suspicion of ureteral valves, directly documented on urography as sharp and transverse filling defects. Retrograde pyelography can better define the obstructing area and documents the normality of the underlying tract. With this procedure, the valvular flaps appear with a superior convexity (like a small umbrella). MR-urography still to be validated clinically, will be able to provide novel perspectives.     

Chemical studies of essential oils of Juniperus oxycedrus ssp. badia

Leaf and (unripe and ripe) berry essential oils of Juniperus oxycedrus ssp. badia (H. Gay) Debeaux grown wild in Spain have been analysed by capillary GC and GC-MS in combination with retention indices. A seasonal investigation of both leaf and berry oils was also performed. Among the approximately 80 constituents investigated (representing 90-98% of the oils) 60-68 were identified (80-97% of the oil composition). The leaf oils were mainly composed of alpha-pinene (40-57%) and manoyl oxide (5-10%). The (unripe) berry oils were dominated by alpha-pinene (65%) with moderate amounts of myrcene, limonene, germacrene D or gamma-muurolene. Several differences in yields and chemical composition from a qualitative and quantitative point of view were detected when comparing all the oil samples analysed. In addition, two oil samples were examined, but found inactive, against the replication of HIV-1(III(B)) and HIV-2(ROD) in cell culture, whereas the samples were toxic for the cells at a 50% cytotoxic concentration of 106 and 123 microg/ml, respectively.     

Metameric motor paresis following abdominal herpes zoster

Motor neuropathy is an uncommon complication that may follow an outbreak of herpes zoster (HZ). About half of the reported cases have involved the cranial nerves, typically the facial nerve. The remaining cases have affected the nerves of the extremities. Interestingly, motor weakness of the thoracic segments is strikingly rare, even though this is where HZ most frequently occurs. The dermatologic literature reports only exceptions to this occurence. We report a new case of motor paresis following HZ infection in an abdominal location, where this complication can be easily misdiagnosed as abdominal herniation.     

A morphometric evidence for a hyperfunctioning mesolimbic system in an animal model of ADHD

The hyperfunctioning dopamine hypothesis in the mesocorticolimbic (MCL) system has been addressed by a neurogenetic approach in model systems. Thus, a morphometric analysis was carried out on neurons of origin of Substantia Nigra (SN) and Ventral Tegmental Area (VTA) dopamine systems of the Naples High-Excitability (NHE), Low-Excitability (NLE) and control lines. Male adult rats were tested in a spatial novelty for indices of activity and non-selective attention. Mesencephalic coronal sections were processed for tyrosine hydroxylase (TH) immunohistochemistry and cytochromoxidase (C.O.) histochemistry. Image analysis in the rostro-caudal plane showed (i) a higher neuron size of TH+ elements in the VTA of NHE and NLE, across the entire structure in the NHE, and only in the middle portion in the NLE; (ii) a higher expression of TH in the neuropil of the VTA in NHE; (iii) a lower C.O. activity in both NLE and NHE; (iv) no differences in the SN. The larger neuron size in both NHE and NLE rats as compared with control rats, along with higher TH expression mainly in the NHE, in absence of any relevant alteration in the SN, reveals an unbalance between the two dopamine systems and a subsequent alteration in limbic (reward, motivation, sustained attention) functions. The decreased C.O. activity might be due to reduced feedback inhibition by striatal GABA neurons and interneurons leading to increased DA neuron firing. In conclusion, the increased behavioral activity and impaired attention observed in the NHE rats are associated to hyperfunctioning MCL system in this genetic model of Attention-Deficit Hyperactivity Disorder (ADHD).     

Chest pain units. Organization and protocol for the diagnosis of acute coronary syndromes

The two main goals of chest pain units are the early, accurate diagnosis of acute coronary syndromes and the rapid, efficient recognition of low-risk patients who do not need hospital admission. Many clinical, practical, and economic reasons support the establishment of such units. Patients with chest pain account for a substantial proportion of emergency room turnover and their care is still far from optimal: 8% of patients sent home are later diagnosed of acute coronary syndrome and 60% of admissions for chest pain eventually prove to have been unnecessary.We present a systematic approach to create and manage a chest pain unit employing specialists headed by a cardiologist. The unit may be functional or located in a separate area of the emergency room. Initial triage is based on the clinical characteristics, the ECG and biomarkers of myocardial infarct. Risk stratification in the second phase selects patients to be admitted to the chest pain unit for 6-12 h. Finally, we propose treadmill testing before discharge to rule out the presence of acute myocardial ischemia or damage in patients with negative biomarkers and non-diagnostic serial ECGs.     

Irinotecan (CPT-11) as first-line monotherapy in patients with advanced, metastatic colorectal cancer refractory to 5-fluorouracil adjuvant chemotherapy: a multicenter phase II study

Irinotecan (CPT-11) is active against colorectal cancer (CRC) refractory to 5-fluorouracil. Further information is needed to confirm whether CPT-11 monotherapy is more effective against tumors than 5-FU monotherapy or if there is cross-resistance of CPT-11 with 5-FU. This study assessed the efficacy and toxicity of CPT-11 350 mg/m² iv, once every 3 weeks, in patients with unsuccessfully pretreated advanced CRC. Thirty-two patients were enrolled and overall 152 cycles were administered. The total objective response rate was 17.9% and the disease stabilized in 11 patients (39.3%). Median time to progression was 3.8 months and me-dian survival was 8.2 months. Grade 3/4 diarrhea was observed in 9 cycles (5.9%) and 6 patients (18.8%), and grade 3/4 neutropenia in 5 cycles (3.3%) and 4 patients (12.5%). CPT-11 monotherapy is an active and well-tolerated first-line chemotherapy for CRC in 5-FU pretreated patients.     

From telescope to binoculars. Dyadic outcome resulting from psychological counselling for infertile couples undergoing ART

Objective: This longitudinal study aims to evaluate the effect of psychological counselling on quality of life, marital satisfaction and need for parenthood in couples undergoing fertility treatments (ART).

Background: Recent guidelines on the ART suggest that psychological counselling should target both members of the infertile couple in order to improve their conjoint management of the infertility-related stress. However, studies on the dyadic outcome of couples are scarce.

Methods: 262 patients were originally considered in the study and completed questionnaires on quality of life, need for parenthood and marital satisfaction, before treatment (T1) and at the day of intrauterine insemination/embryo transfer (T2). For the purposes of this study, 34 counselled couples were then matched to 34 non-counselled couples by propensity scores. The Common Fate Model (CFM) was used to examine dyadic changes.

Results: Couples receiving counselling had higher dyadic quality of life and lower dyadic stress due to the need for parenthood at T2 compared to non-counselled couples. No differences were found on marital satisfaction.

Conclusion: The findings provide support for the effectiveness of counselling on interpersonal outcome. The CFM allows researchers to examine how the dyad as a whole responds to counselling, highlighting the change in the couple’s relational dynamics.     

Bleeding Pseudocyst of the Pancreatic Head. The role of Omentoplasty and Local Hemostasis

Treatment of bleeding psedoaneurysms and pseudocysts of the pancreas is controversial. Surgical treatment with pancreatic resection or trancystic arterial ligation is not always satisfactory since postoperative mortality rate is high, especially for lesions located in the pancreatic head and rebleeding is not unusual. Two patients with bleeding pseudoaneurysms (one post traumatic, one spontaneous) and one with a hemorrhagic pseudocyst of the pancreatic head were treated surgically with arterial suture and omentoplasty. Bleeding was controlled in all, without any postoperative mortality or morbidity. No rebleeding occurred with a follow up of 33, 26 and 12 months. Trancystic ligation of bleeding vessels with omentoplasty may be a useful approach, which should be compared to arterial embolization in the future.