CT findings for postsurgical blind pouch of small bowel

OBJECTIVE: Our objective was to define the CT criteria for blind pouches formed after enteric anastomosis. CONCLUSION: Familiarity with the CT appearance of blind pouches avoids the mistaking of these entities for bowel obstruction or abscesses.     

Radiation dose and contralateral breast cancer risk associated with megavoltage cone-beam computed tomographic image verification in breast radiation therapy

PurposeTo measure and compare organ doses from a standard tangential breast radiation therapy treatment (50 Gy delivered in 25 fractions) and a megavoltage cone-beam computed tomography (MV-CBCT), taken for weekly image verification, and assess the risk of radiation-induced contralateral breast cancer.Methods and MaterialsOrgan doses were measured with thermoluminescent dosimeters placed strategically within a female anthropomorphic phantom. The risk of radiation-induced secondary cancer of the contralateral breast was estimated from these values using excess absolute risk and excess relative risk models.ResultsThe effective dose from a MV-CBCT (8-monitor units) was 35.9 ± 0.2 mSv. Weekly MV-CBCT imaging verification contributes 0.5% and 17% to the total ipsilateral and contralateral breast dose, respectively. For a woman irradiated at age 50 years, the 10-year postirradiation excess relative risk was estimated to be 0.8 and 0.9 for treatment alone and treatment plus weekly MV-CBCT imaging, respectively. The 10-year postirradiation excess absolute risk was estimated to be 4.7 and 5.6 per 10,000 women-years.ConclusionsThe increased dose and consequent radiation-induced second cancer risk as calculated by this study introduced by the imaging verification protocols utilizing MV-CBCT in breast radiation therapy must be weighed against the benefits of more accurate treatment. As additional image verification becomes more common, it is important that data be collected in regard to long-term malignancy risk.     

Neonatal Serum Phosphorus Levels and Enamel Defects in Very Low Birth Weight Infants

Background: Very low birth weight (VLBW) infants miss out on the period of greatest mineral accretion that occurs during the last trimester of pregnancy and are at higher risk of enamel defects. No studies have well described the relationship between neonatal nutrition and dental outcomes in preterm, VLBW infants. The objective of this study was to assess the differences in nutrition biomarkers, feeding intake, and comorbidities among VLBW infants with and without enamel defects. Methods: A retrospective chart review of VLBW infants recruited for an ongoing longitudinal dental study between 2007 and 2010 was done. Participants were classified as cases and controls according to the presence/absence of developmental defects of enamel at 8 and/or 18–20 and/or 36 months. Demographics and medical and nutrition data were abstracted from 76 subjects' medical charts. Results: Of the 76 VLBW subjects, 62% had enamel defects (hypoplasia and/or opacity). The only significant variable in the logistic regression analysis was that infants with a 1‐mg/dL increase in serum phosphorus levels had a 68% reduction in the odds of having enamel hypoplasia (odds ratio, 0.322; P = .024). Conclusion: Neonatal lower serum phosphorus levels are significantly associated with enamel hypoplasia in VLBW infants younger than 3 years.     

SPINK5 and Netherton syndrome: novel mutations, demonstration of missing LEKTI, and differential expression of transglutaminases

Netherton syndrome (NTS) is an autosomal recessive congenital ichthyosis featuring chronic inflammation of the skin, hair anomalies, epidermal hyperplasia with an impaired epidermal barrier function, failure to thrive and atopic manifestations. The disease is caused by mutations in the SPINK5 gene encoding the serine proteinase inhibitor lympho-epithelial Kazal-type inhibitor (LEKTI). Sequence analyses of SPINK5 in seven NTS patients from five different families allowed us to identify two known and three novel mutations all creating premature termination codons. We developed a monoclonal antibody giving a strong signal for LEKTI in the stratum granulosum of normal skin and demonstrated absence of the protein in NTS epidermis. Immunoblot analysis revealed presence of full length LEKTI and of LEKTI cleavage fragments in normal hair roots, whereas in NTS hair roots LEKTI and its cleavage products were completely missing. Transglutaminase1 activity was present throughout almost the entire suprabasal epidermis in NTS, whereas in normal skin it is restricted to the stratum granulosum. In contrast, immunostaining for transglutaminase3 was absent or faint. Moreover, comparable with the altered pattern in psoriatic skin the epidermis in NTS strongly expressed the serine proteinase inhibitor SKALP/elafin and the anti-microbial protein human beta-defensin 2. These studies demonstrate LEKTI deficiency in the epidermis and in hair roots at the protein level and an aberrant expression of other proteins, especially transglutaminase1 and 3, which may account for the impaired epidermal barrier in NTS.     

A potent and selective inhibitor of group IIa secretory phospholipase A2 protects rats from TNBS-induced colitis

Secretory phospholipase A(2) (sPLA(2)) enzymes have been implicated in the pathogenesis of human inflammatory bowel disease (IBD). In this study we compared the efficacy of a potent, new and highly selective inhibitor of group IIa human sPLA(2) enzyme (5-(4-benzyloxyphenyl)-4S-(7-phenylheptanoylamino)-pentanoic acid; sPLA(2)I), with that of sulfasalazine, in a rat model of trinitrobenzene sulfonic acid (TNBS)-induced colitis. Following a single oral dose of sPLA(2)I (5 mg/kg), pharmacoactive levels of drug were detected in the serum within 15 min and for up to 24 h by liquid chromatography mass spectrometry analysis. Rats treated with sPLA(2)I (5 mg/kg/day) prior to induction of colitis were significantly healthier than TNBS-alone rats, as shown by reduced mortality, improved food intake and increased body weight, and significantly reduced colon myeloperoxidase levels, edema, tumour necrosis factor-alpha levels, and colon macroscopic pathology scores after 8 days. Rats pretreated with sulfasalazine (100 mg/kg/day) also had reduced disease expression markers similar to the sPLA(2)I, but exhibited no improvement in colon edema. This study supports a role for the group IIa sPLA(2) enzyme in pathology associated with the TNBS rat model of IBD, and suggests a possible therapeutic application for selective inhibitors of group IIa sPLA(2) inhibitors in the treatment of IBD.     

Detection of medullary thyroid cancer with MIBG imaging for pheochromocytoma

A medullary thyroid cancer (MTC)/multiple endocrine neoplasia syndrome was suspected in a patient having an metaiodobenzylguanidine (MIBG) scan while she was being investigated for pheochromocytoma. After surgery, this was confirmed histologically. Although MIBG scanning cannot be used as a screening tool for MTC because of its poor sensitivity for detection of MTC, this case report highlights that one should always scrutinize the thyroid gland while interpreting MIBG scans.     

An Audit of Hip Radiographs Performed for General Practitioners

AIM: We carried out a prospective study of the GP referrals for hip radiographs to find out the proportion of radiographs falling within the RCR guidelines and to ascertain the reasons for not following the guidelines. MATERIALS AND METHODS: One thousand two hundred and fifty six consecutive hip radiographs were performed for GPs over a 12-month period. Questionnaires were sent to GPs for 873 referrals during an audit period of 18 months Four hundred and fifty three questionnaires were returned with adequate information. The proportion of change in management between the patients falling within the guidelines and those outside the guidelines was compared using Fisher's Exact Test (SPSS Package Version 9) and the corresponding 95% confidence interval (CI) was calculated. RESULTS: Only 194 (43%) of the 453 referrals were within RCR guidelines and 259 (57%) were outside guidelines. In the group where RCR guidelines were followed, 60% were normal, 34% had degenerative changes and 6% other diagnoses. The radiological reports changed management in 44%. In the group where guidelines were not followed 76% were normal, 18% had degenerative changes and 6% other diagnoses. The radiological reports changed management in 37%. There was no evidence of difference in the change in management between these two groups. Twenty per cent of the radiographs showed abnormalities other than hip changes. Of these, only 17% were abnormalities other than degenerative changes and considered significant. CONCLUSIONS: This audit does not reveal why the majority of the requests fell outside guidelines. This may be due to lack of awareness amongst GPs about guidelines, patient pressure, medico-legal problems and the need for reassurance. However, the audit does not show any evidence that following guidelines would increase efficiency of referral.     

Changes in the appearance of attenuation artefacts due to change in posture in myocardial perfusion imaging

OBJECTIVE: Traditional supine imaging with arms raised for myocardial perfusion imaging (MPI) is uncomfortable for many cardiac patients. Seated imaging with arms resting at shoulder level is an attractive alternative. This study aimed to compare the patient comfort and image appearance of seated MPI with traditional supine MPI. METHOD: Sixty-seven patients (41 male, 26 female; body mass index (BMI) between 20.4 and 45.4) were imaged seated on the Mediso Nucline Cardiodesk gamma camera and supine on the GE Millennium VG gamma camera using our standard departmental MPI protocol. The images from each were compared and a questionnaire was used to determine patients' views of the relative comfort of the procedures. RESULTS: Strong patient preference for seated imaging was demonstrated. Perfusion patterns on seated and supine images were strikingly different with the changes seen being greatest and very striking in obese females with seven out of 12 (58%) showing changes of more than two grades. For a subset of 17 normal weight (BMI <25) male patients a significant reduction (P<0.05) in defect size was found in the inferior segment only, signifying a reduction in diaphragmatic attenuation in the seated position. CONCLUSION: Seated imaging offers considerable advantages in terms of patient acceptability. For non-obese men seated imaging also offers advantages in terms of reduced diaphragmatic attenuation artefacts. However, women and also obese men show significant differences in perfusion pattern from traditional supine imaging. A facility for accurate attenuation correction of seated images could provide useful information to elucidate these effects.     

Cancer-associated stromal fibroblasts promote pancreatic tumor progression

Pancreatic adenocarcinoma is characterized by a dense background of tumor associated stroma originating from abundant pancreatic stellate cells. The aim of this study was to determine the effect of human pancreatic stellate cells (HPSC) on pancreatic tumor progression. HPSCs were isolated from resected pancreatic adenocarcinoma samples and immortalized with telomerase and SV40 large T antigen. Effects of HPSC conditioned medium (HPSC-CM) on in vitro proliferation, migration, invasion, soft-agar colony formation, and survival in the presence of gemcitabine or radiation therapy were measured in two pancreatic cancer cell lines. The effects of HPSCs on tumors were examined in an orthotopic murine model of pancreatic cancer by co-injecting them with cancer cells and analyzing growth and metastasis. HPSC-CM dose-dependently increased BxPC3 and Panc1 tumor cell proliferation, migration, invasion, and colony formation. Furthermore, gemcitabine and radiation therapy were less effective in tumor cells treated with HPSC-CM. HPSC-CM activated the mitogen-activated protein kinase and Akt pathways in tumor cells. Co-injection of tumor cells with HPSCs in an orthotopic model resulted in increased primary tumor incidence, size, and metastasis, which corresponded with the proportion of HPSCs. HPSCs produce soluble factors that stimulate signaling pathways related to proliferation and survival of pancreatic cancer cells, and the presence of HPSCs in tumors increases the growth and metastasis of these cells. These data indicate that stellate cells have an important role in supporting and promoting pancreatic cancer. Identification of HPSC-derived factors may lead to novel stroma-targeted therapies for pancreatic cancer.