The value of direct radionuclide cystography in the detection of vesicoureteral reflux in children with normal voiding cystourethrography

Background

Vesicoureteral reflux (VUR) is one of the most important risk factors for urinary tract infection (UTI). Diagnosis and treatment of VUR is important to prevent irreversible complications, such as renal scarring and chronic renal failure. This study was conducted to assess the value of direct radionuclide cystography (DRNC) in the detection of VUR in children with UTI and a normal voiding cystourethrography (VCUG).

Methods

DRNC was performed in 35 children with a normal VCUG after an episode of febrile UTI who had hydronephrosis or hydroureter, abnormal acute dimercaptosuccinic acid (DMSA) scan results and/or febrile UTI recurrence. This study was conducted in the nephrology department of Mofid Children’s Hospital, Tehran (Iran).

Results

The results were statistically analyzed. Among the 70 ureters studied, 33 (49.1 %) were observed to have VUR. Of these, 17 (51.5 %) had mild, 14 (42.4 %) moderate, and 2 (6.1 %) severe reflux. A significant relationship was observed between DRNC results and DMSA renal scan findings (P?<?0.05).

Conclusions

Based on our results, we suggest that DRNC may reveal VUR despite a normal VCUG in children with hydronephrosis, abnormal acute DMSA, and/or recurrent febrile UTI.

     

FDG PET/CT in Crohn’s disease: correlation of quantitative FDG PET/CT parameters with clinical and endoscopic surrogate markers of disease activity

Purpose

The aim of this study was to determine the feasibility and potential clinical utility of assessment of Crohn’s disease (CD) activity by ¹⁸F-fluorodeoxyglucose (FDG) positron emission tomography (PET)/CT employing a new quantitative approach.

Methods

A total of 22 subjects (mean age 37) with CD who had undergone FDG PET/CT followed by ileocolonoscopy within 1 week were included in this analysis. The CD endoscopy index of severity (CDEIS) for various bowel segments was calculated. The CD activity index (CDAI) was evaluated, and fecal calprotectin was measured. On PET, regions with increased FDG uptake in large bowel were segmented with an adaptive contrast-oriented thresholding algorithm, and metabolically active volume (MAV), uncorrected mean standardized uptake value (SUV_mean), partial volume-corrected SUV_mean (PVC-SUV_mean), SUV_max, uncorrected total lesion glycolysis (TLG = MAV × SUV_mean), and PVC total lesion glycolysis (PVC-TLG = MAV × PVC-SUV_mean) were measured. Global CD activity score (GCDAS) was calculated as the sum of PVC-TLG over all clinically significant FDG-avid regions in each subject. Correlations between regional PET quantification measures (SUVs, TLGs) and CDEIS were calculated. Correlations between the global PET quantification measure (GCDAS, global SUVs) with CDAI, fecal calprotectin, CDEIS, and CRP level were also calculated.

Results

SUV_max, PVC-SUV_mean, and PVC-TLG significantly correlated with segment CDEIS subscores (r?=?0.50, r?=?0.69, and r?=?0.31, respectively; p?<?0.05). GCDAS significantly correlated with CDAI and fecal calprotectin (r?=?0.64 and r?=?0.51, respectively; p?<?0.05).

Conclusion

By employing this new quantitative approach, we were able to calculate indices of regional and global CD activity, which correlated well with both clinical and pathological disease activity surrogate markers. This approach may be of clinical importance in measuring both global disease activity and treatment response in patients with CD.     

Gas chromatography-mass spectrometry analysis of various organic extracts of Merremia borneensis from Sabah

ObjectiveTo analyse the chemical composition of different extracts of Merremia borneensis (M. borneensis) by gas chromatography-mass spectrometry (GC-MS).MethodsThe dried leaves powder was extracted with methanol at room temperature by using Soxhlet extractor. Methanol crude extracts of M. borneensis were extrastel with hexane, chloroform, ethyl acetate and butanol.ResultsQualitative analyses of various organic crude extracts showed that majority of these are flavonoids, terpeniods, alkaloids and glycosides. Most of the identified compounds by GC-MS are biologically important. Further the M. borneensis leaf possesses certain characteristics that can be ascribed to cultivation on a domestic plantation.ConclusionsThe suitable extracts for respective compounds can be chosen on the basis of above GC-MS analysis. All the major compounds from different extracts are biologically active molecules. Thus the identification of a good number of compounds from various extracts M. borneensis might have some ecological significance.     

Use of Lipid-Lowering Agents for the Prevention of Age-Related Macular Degeneration: A Meta-Analysis of Observational Studies

Purpose : To examine the effect of lipid-lowering agents in the development of age-related macular degeneration (AMD) through the techniques of meta-analysis. Methods : Case-control and cohort studies presenting relative risks and 95% confidence intervals were identified through a literature review. Inclusion was limited to studies where both the exposure of interest (lipid-lowering agents) and outcome (AMD) were explicitly defined. Pooled estimates were computed using the random effects model. To quantify heterogeneity we calculated the proportion of total variance of between study variance using the Ri statistic. The Q statistic for heterogeneity was also calculated. Results : Eight studies were identified. The pooled relative risk (RR) for all studies was 0.74 (95% CI, 0.55–1.00). When only those studies examining the use of statins were pooled (n = 7), the RR was 0.70 (95% CI, 0.48–1.03). Using the Ri statistic, the heterogeneity between studies was found to be 0.85 for all studies and 0.89 for studies examining statins. Conclusion : Lipid-lowering agents, including statins, do not appear to lower the risk of developing AMD, although clinically significant effects cannot be excluded. The use of these agents in the prevention of AMD cannot be recommended until well designed prospective studies with long follow up have demonstrated a benefit.     

A 75-year old man complaining of flank pain and obstructive urinary symptoms: a case report

Benign renal cystic adenoma with out malignant features is a very rare entity. A 75 year old male with obstructive Lower tract symptoms and vague flank pain was admitted and planned for nephrectomy of non functional kidney -due to long term nephrolithiasis- intra operative finding was a cystic hydronephrotic kidney filled by thick mucous secretions which turned out to be a cyst adenoma of kidney with no malignant features.     

Overuse or underuse of MRI scanners in private radiology centers in Tehran

OBJECTIVES: The semiprivate health system in Iran has created an opportunity for unnecessary uses of advanced medical equipments including magnetic resonance imaging (MRI). This study aimed to evaluate the evidence for MRI overuse in private diagnostic imaging centers in Tehran, Iran. The objectives of this study were to determine the frequency of use of MRI scans for different complaints and to explore frequency of normal MRI findings as a function of unnecessary MRI use. METHODS: We conducted a survey among private MRI centers in Tehran, Iran, to study the proportion of MRI scans that may result in significant clinical finding. All MRI reports at a specific point in time at selected MRI centers were reviewed by a physician and the findings were recorded as normal, abnormal, or substantial changes. RESULTS: Of all the MRI reports, 17.2 percent had resulted in normal findings; 9.8 percent ordered for examination of headache, and 4.8 percent for lower back pain. CONCLUSION: Unnecessary MRIs are most likely to result in normal finding; although not all the MRI with normal results could be identified as unnecessary. Negative findings from MRI scans may be reassuring to both clinicians and patients. The proportion of normal findings in MRI scans did not provide evidence of MRI overuse in Iran. The results of this study warrant formation of guidelines for the use of MRIs for headache and low back pain disorders.     

Ocular Manifestations,Conventional Fundus Fluorescein Angiographic Findings,and Relationship Between Angiographic Findings and Visual Acuity in Behçet’s Disease

Purpose: Evaluating the ocular manifestation and fundus fluorescein angiography (FA) findings of patients with Behçet’s disease as well as the relationship between visual acuity and angiographic findings. Methods: Retrospective chart review of patients with Behçet’s disease seen at the Farabi Eye Hospital. Results: Forty-six patients (92 eyes) with mean age of 33.41 ± 10.67 were included. The most frequent presenting symptom and sign were reduced vision (76%) and uveitis (87%), respectively. Panuveitis was the most frequent type of uveitis (76%). Among patients with FA, vasculitis was the most common finding (87%) and it was significantly more severe among patients with visual acuity less than 20/200. Macular leakage (P = 0.001), arterial narrowing (P = 0.000), and posterior retinal vasculitis (P = 0.002) on FA were all associated with worsening final visual acuity. Conclusion: The most common ocular findings in Behçet’s disease were panuveitis and vasculitis. Location of vasculitis, arterial narrowing, and macular leakage on initial FA may predict visual prognosis.