Sonography, CT, and MRI appearance of the Essure microinsert permanent birth control device

OBJECTIVE: The purpose of this article is to describe the appearance and location of the Essure permanent birth control device on sonography, CT, and MRI. CONCLUSION: The Essure device has a distinct appearance and typical location that allow it to be accurately identified on sonography, CT, and MRI scans.     

Epilepsy surgery for the neurocutaneous disorders

Patients with neurophakomatoses were not always considered to be candidates for surgical resection of epileptogenic foci, given the multifocal nature of their disease. Advances in imaging, monitoring, and surgical technique have allowed the identification of particularly active areas of cortex that may provide these patients with better seizure control than medications alone. Options for surgical resection range from focal resections (in those with localized disease) to hemispherectomies (in those with hemispheric involvement).     

Replication-attenuated Human Adenoviral Type 4 vectors elicit capsid dependent enhanced innate immune responses that are partially dependent upon interactions with the complement system

Human Adenovirus Type 4 (HAdV-4) is responsible for epidemic outbreaks of Acute Respiratory Disease (especially in military recruits), and is known to cause significant morbidity with several reported cases of mortality. However, we do not understand why this serotype causes such high morbidity, and have little insight into the immunobiology of HAdV-4 infections. We have now developed a replication attenuated HAdV-4 vector system, and through it, demonstrate that HAdV-4 virions have enhanced infectivity of certain cell types and reveal aspects of the serotype-specific heightened innate immunogenicity of infectious HAdV-4 capsids both in vitro and in vivo. We further found that elements of this serotype-specific immunogenicity were dependent upon interactions with the complement system. These findings provide insights into the mechanisms possibly underlying the known morbidity accompanying wild-type HAdV-4 infections as well as highlight important considerations when considering development of alternative serotype vectors.     

MR urography for suspected upper tract urothelial carcinoma

The key components of the MR urography protocol for suspected upper tract urothelial carcinoma are coronal T2-weighted hydrographic sequences without contrast agent and coronal gadolinium-enhanced T1-weighted 3D-spoiled gradient-recalled echo in nephrographic and pyelographic phases. Upper tract urothelial carcinomas can be categorized into papillary tumor, flat tumor, and infiltrative tumor based on the growth pattern and extent. Papillary lesions appear as small filling defects of soft tissue signal on T2-weighted hydrographic and T1-weighted pyelographic phase images. On nephrographic phase images, the lesions show homogeneous enhancement. A flat tumor appears as a segmental area of diffuse thickening and enhancement of the urinary tract wall on nephrographic phase images. Infiltrative tumor often appears as a large heterogeneously enhancing mass. MR urography is a promising alternative for CT urography in the evaluation of upper tract urothelial carcinoma, especially when the patient has a contraindication to iodinated contrast material.     

Pharmacokinetic analysis of dextran sulfate in rats as pertains to its clinical usefulness for therapy of HIV infection.

We administered radiolabeled dextran sulfate (3H labeled on the reducing end, MW approximately 8000) [( 3H]DS) to rats. High-performance liquid chromatography (HPLC) analysis of plasma from animals that were given [3H]DS intravenously revealed an initial plasma half-life of about 30 min. Eleven percent of [3H]DS administered was recovered in the urine in 24 h; this material represented minor breakdown with a molecular weight of 4000 as determined by size exclusion HPLC analysis. When administered orally, the apparent bioavailability of [3H]DS was 6.8%, based on the recovered radioactivity; however, the molecular weight of the radioactive material obtained from the plasma was all less than 200, indicating that no detectable intact dextran sulfate was absorbed upon oral administration. Only 2% of orally administered [3H]DS was found in the 24-h urine; this material also had a molecular weight less than 200. Further less than 2300 had no anti-HIV effect and that in the presence of higher concentrations of human serum, more DS was required for antiviral effect. Although the pharmacokinetics of dextran sulfate in rats can differ from those in humans to some extent, these data suggest that oral administration of DS is unlikely to produce significant antiretroviral effect against HIV in vivo and higher plasma levels of DS may be necessary than those inferred from earlier in vitro data.     

Pharmacological characterization of WAY-121,520: A potent anti-inflammatory indomethacin-based inhibitor of 5-lipoxygenase (5-LO)/phospholipase A2 (PLA2)

WAY-121,520 inhibited human synovial fluid PLA₂ (HSF-PLA₂) (IC₅₀=4 M) using arachidonic acid-labeledE. coli as substrate. Further biochemical characterization of WAY-121,520 demonstrated potent inhibition of 5-lipoxygenase (5-LO) activity in the murine macrophage (LTC₄, IC₅₀=4nM) and rat PMN (LTB₄, IC₅₀=10 nM) and an ability to antagonize LTD₄ binding to isolated guinea-pig trachea (pK _B=6.0).In vivo anti-inflammatory activity was noted in murine TPA-induced (ED₅₀=91 g/ear) and arachidonic acid-induced (66% inhibition at 400 g/ear) ear edema and in leukotriene-dependent antigen-induced bronchoconstriction in the guinea pig (73% inhibition at 50 mg/kg, p.o.). WAY-121,520 represents a novel series of indomethacin-based inhibitors of PLA₂ with anti-inflammatory activity resulting from a combination of biochemical activities (inhibition of 5-LO and PLA₂ and LTD₄ antagonism). This agent may provide added therapeutic efficacy over more selective inhibitors.     

Medically unexplained symptoms, somatisation disorder and hypochondriasis: Course and prognosis. A systematic review

Objective

To study the course of medically unexplained symptoms (MUS), somatisation disorder, and hypochondriasis, and related prognostic factors. Knowledge of prognostic factors in patients presenting persistent MUS might improve our understanding of the naturalistic course and the identification of patients with a high risk of a chronic course.

Methods

A comprehensive search of Medline, PsycInfo, CINAHL, and EMBASE was performed to select studies focusing on patients with MUS, somatisation disorder, and hypochondriasis, and assessing prognostic factors. Studies focusing on patients with single-symptom unexplained disorder or distinctive functional somatic syndromes were excluded. A best-evidence synthesis for the interpretation of results was used.

Results

Only six studies on MUS, six studies on hypochondriasis, and one study on abridged somatisation could be included. Approximately 50% to 75% of the patients with MUS improve, whereas 10% to 30% of patients with MUS deteriorate. In patients with hypochondriasis, recovery rates vary between 30% and 50%. In studies on MUS and hypochondriasis, we found some evidence that the number of somatic symptoms at baseline influences the course of these conditions. Furthermore, the seriousness of the condition at baseline seemed to influence the prognosis. Comorbid anxiety and depression do not seem to predict the course of hypochondriasis.

Conclusions

Due to the limited numbers of studies and their high heterogeneity, there is a lack of rigorous empirical evidence to identify relevant prognostic factors in patients presenting persistent MUS. However, it seems that a more serious condition at baseline is associated with a worse outcome.     

Posthemispherectomy hydrocephalus: Results of a comprehensive,multiinstitutional review

Purpose: Hemispherectomy surgery for medically intractable epilepsy is known to cause hydrocephalus in a subset of patients. Existing data regarding the incidence of, and risk factors for, developing posthemispherectomy hydrocephalus have been limited by the relatively small number of cases performed by any single center. Our goal was to better understand this phenomenon and to identify risk factors that may predispose patients to developing hydrocephalus after hemispherectomy surgery. Methods: Fifteen pediatric epilepsy centers participated in this study. A retrospective chart review was performed on all available patients who had hemispherectomy surgery. Data collected included surgical techniques, etiology of seizures, prior brain surgery, symptoms and signs of hydrocephalus, timing of shunt placement, and basic demographics. Key Findings: Data were collected from 736 patients who underwent hemispherectomy surgery between 1986 and 2011. Forty‐six patients had preexisting shunted hydrocephalus and were excluded from analysis, yielding 690 patients for this study. One hundred sixty‐two patients (23%) required hydrocephalus treatment. The timing of hydrocephalus ranged from the immediate postoperative period to 8.5 years after surgery, with 43 patients (27%) receiving shunts >90 days after surgery. Multivariate regression analysis revealed anatomic hemispherectomies (odds ratio [OR] 4.1, p < 0.0001) and previous brain surgery (OR 1.7, p = 0.04) as independent significant risk factors for developing hydrocephalus. There was a trend toward significance for the use of hemostatic agents (OR 2.2, p = 0.07) and the involvement of basal ganglia or thalamus in the resection (OR 2.2, p = 0.08) as risk factors. Significance: Hydrocephalus is a common sequela of hemispherectomy surgery. Surgical technique and prior brain surgery influence the occurrence of posthemispherectomy hydrocephalus. A significant portion of patients develop hydrocephalus on a delayed basis, indicating the need for long‐term surveillance.