The position of the vertebral artery V1 segment relative to the C7 vertebra

BackgroundThe vertebral artery (VA) usually enters the transverse foramen at the C6 level. Thus, surgeons prefer to insert pedicle screws (PSs) at C7, but this does not eliminate the risk of VA injury. We aimed to clarify anatomical features of the VA V1 segment at the C7 pedicle level, based on computed tomographic angiography (CTA) of 81 consecutive patients.MethodsWe examined the course of the VA V1 segment on axial CTA images. VA position was classified according to its alignment with the anterior (A), middle (M), or posterior (P) third of the C7 vertebral body at the pedicle level. We also assessed the prevalence of hypoplastic VA (HVA). We measured the distance (VED) from the optimum C7 PS entry point (Ep) to the center of the VA. We also measured the angles formed by the vertebral midline and a line from the inner edge of the VA to the Ep (the VEA), and by the vertebral midline and a line from the inner edge of the pedicle to the Ep (the PEA).ResultsThe variant location of the VA to the C7 vertebra was A in 13 courses (8.1%), M in 123 (76.9%), and P in 20 (12.5%). HVA was present in the contralateral side in 7 of 20 courses (35%) in the P group, and in 8 of 127 courses (6.3%) in the M group (p < 0.05). The mean VED was 20.2 mm, the mean VEA 6.9°, and the mean PEA angle was 36.3°.ConclusionThe 20 VA courses in the P group (12.5% of the total VA courses) were relatively close to the C7 Ep. HVA was present contralateral to the VA in 7 of 20 courses in the P group. CTA should be considered before proceeding with, even if, C7 PS instrumentation, to avoid unexpected pitfall.     

Esophageal transit scintigraphy and structured questionnaire in patients with systemic sclerosis with endoscopically proven reflux esophagitis

Objectives  

Esophageal complications are common in patients with systemic sclerosis (SSc). The relationship between gastroesophageal reflux (GER) symptoms and dysmotility was examined in endoscopically confirmed patients suspected of having reflux esophagitis.     

Bone scintigraphy as a new imaging biomarker: the relationship between bone scan index and bone metabolic markers in prostate cancer patients with bone metastases

Objective

A computer-aided diagnosis system for bone scintigraphy with a semiquantitative index from the Bone Scan Index (BSI) has been used to quantify the spread of bone metastases. However, few papers have made clear associations among BSI, bone metabolic markers, and prostate-specific antigen (PSA). This retrospective study aimed to examine these relationships in prostate cancer patients with bone metastases.

Methods

A total of 158 scans from 52 patients (number of median examinations/person 3, range 1–8; median age 71 years, age range 46–86) were included. The intervals between bone scans and blood examinations were 0–16 days (median 0 day). The serum markers of PSA, pyridinoline cross-linked carboxy-terminal telopeptide of type I collagen (1-CTP), bone alkaline phosphatase (BAP), and tartrate-resistant acid phosphatase-5b (TRACP-5b) were examined. Subjects were divided into 4 groups according to BSI; Group A: 0 to <2, Group B: 2 to <4, Group C: 4 to <8, and Group D: over 8. BSI, which corresponded to the amount of metastatic lesion, was automatically calculated by BONENAVI^® software (FUJIFILM RI Pharma, Co. Ltd., Tokyo, Japan; Exini Bone, Exini Diagnostics, Sweden).

Results

All bone scans showed high uptake with bone metastases. BSI was correlated significantly with the serum 1-CTP, serum BAP, serum TRACP-5b, logBAP, logTRACP-5b, and logPSA (r = 0.39, 0.66, 0.69, 0.71, 0.62 and 0.41, respectively). BSI did not correlate significantly with the serum PSA. The statistical F value was 11 in the serum 1-CTP, 31 in serum BAP, 29 in logBAP, 19 in serum TRACP-5b, 14 in logTRACP-5b, 3 in serum PSA, and 9 in logPSA by analysis of variance. Comparison by Dunnett’s test showed significantly higher values in Group D for all original bone metabolic markers and the logPSA, Group C for the serum BAP, logBAP, serum TRACP-5b, and logTRACP-5b, and Group B for the logTRACP-5b compared with Group A.

Conclusion

The changes in BSI showed a close relationship with all bone metabolic markers but not with the serum PSA. The BSI is confirmed to reflect the activity and extent of bone metastases, and can be used as an imaging biomarker.     

Passive toothbrushing-induced seizures: Report of a severely disabled girl

Toothbrushing-induced seizures are rare reflex seizures triggered by the brushing of one’s own teeth. We encountered an 11-year-old girl with severe mental retardation, hypotonic cerebral palsy and epilepsy who presented with toothbrushing-induced seizures. She had had spontaneous brief tonic seizures several times a day since the age of 1 year and 2 months and started presenting with the same type of seizures induced by toothbrushing from the age of 8 years. As she could not brush her teeth by herself due to her disabilities, her mother brushed her teeth daily for her. The interictal EEG showed spike-and-wave complexes in the frontal regions bilaterally. The [Tc-99m]HMPAO-SPECT at the time of the seizure induced by toothbrushing suggested that the seizures originated from the left perisylvian cortex. This is the first report of toothbrushing-induced seizures triggered by the brushing of the patient’s teeth by another person (‘passive toothbrushing’).     

Can MRI-derived depth of invasion predict nodal recurrence in oral tongue cancer?

Objectives

To evaluate the prognostic value of preoperative radiological findings for nodal recurrence in clinically node-negative (cN0) patients with oral tongue squamous cell carcinoma (SCC).

Methods

The study population consisted of 52 patients with cT1-2N0 oral tongue SCC classified according to the 7th edition of the Union for International Cancer Control (UICC) staging system. The subjects had undergone preoperative radiological examinations, including magnetic resonance imaging (MRI) and ¹⁸F-fluorodeoxyglucose (FDG)-positron emission tomography (PET)/computed tomography. All patients were treated with local resection and watchful waiting for neck management. Using an unpaired t test, Pearson’s chi-squared test, and the Kaplan–Meier method, the MRI-derived depth of invasion (DOI), the standardized uptake value (SUV) on FDG-PET, and the T stage according to the 7th and 8th UICC were assessed as prognostic factors.

Results

The MRI-derived DOI was recorded as?≤?5 mm in 24 patients and?>?5 mm in 28 patients. During the follow-up period, nine patients exhibited nodal recurrence, with the MRI-derived DOI being significantly higher in patients with positive than in those with negative (p?=?0.011). The SUV was not significant. Five-year cumulative nodal recurrence probabilities were 4.5% for patients with an MRI-derived DOI?≤?5 mm, while it was 32.1% for?>?5 mm (p?=?0.013). Although the T classifications were not significant, none of our patients whose T stage according to the 8th UICC was T1 suffered nodal recurrence.

Conclusions

MRI-derived DOI can predict nodal recurrence, while preoperative information may assist in treatment planning for oral tongue SCC.

     

Rapid determination of disulfoton and its oxidative metabolites in human whole blood and urine using QuEChERS extraction and liquid chromatography-tandem mass spectrometry

A liquid chromatography-tandem mass spectrometry method was developed and validated for simultaneous determination of disulfoton and five of its oxidative metabolites (disulfoton-sulfoxide, disulfoton-sulfone, demeton-S, demeton-S-sulfoxide and demeton-S-sulfone) in human whole blood and urine. Extraction was undertaken using a QuEChERS method, which is commonly used in food analysis. D(10)-Disulfoton was used as the internal standard. Separation was carried out using a CAPCELL-PAK MG II column (35×2.0mm i.d., 5μm, Shiseido) with a mobile phase of 10mmol/L ammonium formate and methanol. This method was applied in an autopsy case, and disulfoton and its oxidative metabolites were successfully detected in both blood and urine. The concentrations of disulfoton in the blood and urine were 360 and 23.8ng/mL, respectively. There was a relatively low concentration of demeton-S in both the blood (4.0ng/mL) and urine (45.7ng/mL). To date, there have been no reported cases of detection of demeton-S in human samples.     

Prognostic Value of Early Evaluation of Left Ventricular Dyssynchrony After Myocardial Infarction

Molecular Imaging and Biology - Dispersion in the contraction of the normally coordinate ventricular system, referred to as left ventricular (LV) dyssynchrony, is constantly observed at different...     

Fibroma of the tendon sheath that expanded into the radiocarpal joint with bony involvement.

We present a 46-year-old man with a fibroma of the tendon sheath of the left radiocarpal joint and bony involvement of the scaphoid and the radial styloid. Bony involvement of a fibroma of the tendon sheath is rare and has been reported only four times to our knowledge.     

Alpha interferon raises serum beta-2-microglobulin in patients with multiple myeloma

Serum beta 2-microglobulin (beta 2m) levels were followed in eight patients with multiple myeloma who were treated with leucocyte alpha interferon (alpha IFN) 6 x 10(6) IU daily for 1-2 weeks before chemotherapy. Serial measurements of serum beta 2m were carried out regularly during the first week on alpha IFN. A rise in beta 2m was observed in all patients. with maximum increments ranging from 29% to 185% (mean 109%). The increase in beta 2m was most marked in patients with elevated pretreatment levels of serum beta 2m and creatinine. In six patients the peak value was reached between the third and the fifth day, after which the levels decreased. In two patients serum beta 2m remained elevated for 3 and 4 months, respectively. A marked increase in serum beta 2m can be induced by alpha IFN in myeloma, which should be taken into consideration when using beta 2m for the assessment of tumour response during alpha IFN therapy.