Magnetic resonance imaging in the diagnosis and staging of renal and perirenal neoplasms

Thirty-one adult patients underwent magnetic resonance (MR) imaging after CT scans had demonstrated findings consistent with renal cell carcinoma. MR images were interpreted prospectively and independently of the CT findings. Because the CT scanning was performed at multiple institutions by many examiners, this study was not a direct comparison of CT versus MR. The preoperative diagnoses and staging of the neoplasms, as judged by MR, were compared with those obtained at laparotomy (n = 28), autopsy (n = 1), or biopsy (n = 2). Correct preoperative diagnoses were rendered in 31 patients (100%) on the basis of MR findings. The anatomic staging of 27 renal cell carcinomas was correctly performed by MR in 26 patients (86%). When compared with results of previous studies of the value of CT in the diagnosis and staging of renal neoplasms, MR appears to have several advantages in determination of the origin of the mass; the evaluation of vascular patency; the detection of perihilar lymph node metastases; and the evaluation of direct tumor invasion of adjacent organs. MR is sensitive in determining the extent of tumor thrombus and in evaluating invasion of the inferior vena caval wall. MR should assume an important role in the diagnosis and staging of renal neoplasms.     

Reciprocal up- and down-regulation of BDNF mRNA in tetanus toxin- induced epileptic focus and inhibitory surround in cerebral cortex

Chronic focal epilepsy is associated with synaptic plasticity and growth of new connections. Brain-derived neurotrophic factor (BDNF) is associated with each of these processes in normal brain and shows acute up-regulation in models of generalized epilepsy. Here, using an experimental model of focal epilepsy, we show persistent up-regulation of BDNF mRNA, independent of that of other growth factors, in association with the development and persistence of chronic seizures. In situ hybridization histochemistry revealed that rats perfused within 2-3 days after seizure onset had widespread increases in BDNF mRNA levels in the neocortex. Rats perfused at later times, however, showed focal up-regulation of BDNF mRNA at the injection site and down- regulation in a surrounding cortical zone. Nerve growth factor and neurotrophin-3 mRNAs were not significantly altered. These reciprocal changes in BDNF gene expression in the epileptic focus and the cortical surround may contribute to plastic changes in epileptic neuronal circuits that accompany the transition from acute to chronic epilepsy. BDNF down-regulation in the surround is likely to be associated with the inhibitory surround that hampers seizure spread, but facilitates the persistence of a chronic epileptic focus.      

Infant feeding effects on flow cytometric analysis of blood

Flow cytometric analysis was performed on purified mononuclear cells isolated from whole blood samples of 11 adults, 7 breast-fed (BF) infants and 11 formula-fed (FF) infants, mean ages 34.2 +/- 4.3 years, 6.3 +/- 1.3 months, and 6.2 +/- 1.2 months, respectively. Infants were receiving at least 70% of calories from formula or breast milk. Infant mononuclear cell populations contained a higher percentage of lymphocytes and a lower percentage of monocytes compared with adults. Within the lymphocyte population, infants had a higher CD4+/CD8+ ratio (T helper-inducer/T cytotoxic-suppressor), a higher percentage of CD19+ (pan B) and CD4+ cells, and a lower percentage of CD8+ and CD16+ (natural-killer) cells compared with adults. CD3+ (pan T) and CD4+ lymphocyte percentages were higher and CD19+ lymphocyte percentages were lower in FF compared with BF infants. Although sample size is small, our data indicate that diet may influence lymphocyte subset distribution during infancy when the majority of calories is derived from infant formula or human milk.     

CLINICO PATHOLOGY CONFERENCE: INFANT WITH HIGH ARCHED PALATE, BELL-SHAPED CHEST, JOINT CONTRACTURES, AND INTRAUTERINE FRACTURES

A case is presented of a female newborn infant delivered with an Apgar Score of 1, who could not be resuscitated. There was a high arched palate, bell-shaped chest, contractures of writes inflexion, ankles and knees in extension, and intrauterine fractures. Clinical discussion led to a diagnosis of arthrogryposis secondary to fetal akinesia syndrome caused by nemaline myopathy. Pathology and pathologic discussion confirmed this diagnosis.     

Comparison between anatomical polyester (Parietex) mesh and polypropylene (Prolene) mesh with fixation in total extraperitoneal repair for inguinal hernia

Introduction: Laparoscopic inguinal hernia surgery has been gaining in worldwide popularity, with the total extraperitoneal (TEP) repair gaining greater acceptance than the transabdominal pre‐peritoneal repair. Most techniques using TEP advocate some form of fixation of the prosthesis, but newer meshes avoid the use of fixation. Methods: We compared the use of the polyester mesh (Parietex; Tyco, Princeton, USA) without fixation and polypropylene (Prolene; Ethicon, USA) mesh with fixation using either ProTack (Tyco, USA) or EndoAnchor (Ethicon, Cincinnati, USA) in a consecutive series of patients who underwent total TEP endoscopic inguinal hernia repair. Results: Of 127 patients who underwent TEP repairs, 60 had Parietex mesh while 67 had Prolene mesh with fixation. The mean age was 50 years old and 97% were men. There was no difference in patient demographics or complication rate. The most common complication was small seroma or hematoma formation in 14% of patients and none required re‐operation. There was no hernia recurrence in either group with a mean follow‐up period of 13 months. Conclusion: This study shows that in laparoscopic TEP inguinal hernia repair, early results indicate comparable results between the use of polyester (Parietex) mesh without fixation and polypropylene (Prolene) mesh with fixation.