Funktionelle MRT des Beckenbodens: Normale Anatomie und pathologische Befunde

Zusammenfassung Ziel. Die funktionelle MRT des Beckenbodens erm?glicht die Dokumentation und Definition der verschiedenen Manifestationsformen einer Beckenbodeninsuffizienz. Methodik. Es wurde bei 39 gesunden Nulliparen und 324 Patientinnen eine funktionelle MRT des Beckenbodens durchgeführt. Ein pathologischer Organdeszensus wurde dokumentiert, wenn bestimmte Kennstrukturen der Beckenbodenkompartimente unterhalb der pubokokkygealen Referenzlinie (PC-Linie) zu liegen kamen. Ergebnisse. Beim Normalbefund zeigt sich unter Pressen kein Deszensus der Kennstrukturen unterhalb der PC-Linie und die Beckenbodenmuskulatur ver?ndert ihre Position kaum. In 70% fand sich die kombinierte Form eines Organdeszensus. Die meist stufenweise Entwicklung eines Organvorfalles führte bei 21,6% zu einem Wechsel des Hauptbefundes. Am h?ufigsten war hierbei die Maskierung einer Zystozele (48,6%) oder einer Enterozele (34,3%) durch eine Rektozele. Diskussion. Der Einsatz der funktionellen MRT des Beckens erscheint insbesondere bei jungen Patientinnen gerechtfertigt, und in F?llen, in denen klinische und sonographische oder r?ntgenologische Befunde divergieren sowie bei einem vermuteten dominanten Brucksack mit oder ohne Peritoneozele, bzw. Enterozele.      

Tuberculosis of the pancreas in a HIV-seropositive patient]

A 34-year-old man from Nigeria who had resided permanently in the Netherlands for five years had experienced fever, upper abdominal pain and weight loss for several months. He did not give the impression of being ill. A CT scan gave cause to suspect pancreatitis. An HIV test gave a positive result. Puncture of the accumulated fluid around the pancreas led to the diagnosis 'tuberculosis' (infection by Mycobacterium tuberculosis). Once the patient had made a good recovery with antituberculosis therapy, antiretroviral therapy was initiated, whereupon the number of CD4+ cells in the blood increased. Extrapulmonal tuberculosis is not unusual in HIV seropositive patients from countries with a high prevalence of tuberculosis. However, in such patients isolated tuberculosis of the pancreas is unusual and has not previously been described in the Netherlands. The diagnosis can be established following a CT guided puncture; tuberculosis is instantly suspected if the Ziehl-Neelsen stains are positive and the diagnosis can then be confirmed by a polymerase chain reaction (PCR) analysis and by culturing. Anti-retroviral therapy is withheld until response to anti-tuberculosis treatment is satisfactory.     

Intratracheal surfactant administration restores gas exchange in experimental adult respiratory distress syndrome associated with viral pneumonia.

The effect of intratracheal surfactant administration was studied in rats with adult respiratory distress syndrome associated with infection with nebulized Sendai virus. Thirty-six hours after infection, animals (n = 7) showed severely impaired gas exchange and acidosis during artificial ventilation (PaO2 = 152.2 +/- 18.7, PaCO2 = 65.3 +/- 19.2, pH = 7.26 +/- 0.11) with a pressure-controlled mode, standard frequency of 35/min, peak airway pressure of 15 cm H2O (15/0), inspiratory/expiratory ratio of 1:2, and F1O2 = 1. Gas exchange improved (P = 0.02) with increased ventilator pressures with PEEP (25/4). Forty-eight hours after infection, blood gas tensions could no longer be significantly improved by these same ventilator settings (PaO2 = 123.8 +/- 31.0, PaCO2 = 95.1 +/- 43.6, pH = 7.12 +/- 0.16, n = 9). At this time, surfactant replacement dramatically increased arterial oxygenation within 5 min (PaO2 = 389.4 +/- 79.9) and resulted in a fourfold increase in PaO2 within 2 h. It is concluded that intratracheal surfactant administration is a promising approach in the treatment of respiratory failure during adult respiratory distress syndrome associated with viral pneumonia.     

Transesophageal cardiac pacing during magnetic resonance imaging: Feasibility and safety considerations

The feasibility and safety of transesophageal cardiac pacing during clinical MRI at 1.5 Tesla is considered. An MRI compatible pace catheter was developed. In vitro testing showed a normal performance of the pulse generator, image artifacts that extended less than 11 mm from the catheter, and a less than 5% increase in noise. Cardiac stimulation induced by MRI was not observed and, theoretically, is not expected. Potentially, tissue around the catheter tip may become heated. This heating (ΔT) was monitored. Eight dogs were exposed to MRI during pacing. For low RF radiation exposure, a time-averaged squared B₁ field below 0.08 pT² (SAR < 0.03 W/kg), ΔT was below 1°C. For high RF radiation exposure, but at normal RF radiation specific absorption rate (0.4 W/kg), ΔT was 5°C. Thus, transesophageal atrial pacing during MRI at low RF exposure seems to be possible to perform cardiac stress studies or to correct unstable heart rates.     

Hemorrhagic fever caused by dengue in 2 tourists]

Dengue haemorrhagic fever in two female tourists to Thailand (1990) and Indonesia (1989) respectively, is reported for the first time in the Netherlands. The main symptoms directly after return were high fever, haemorrhagic exanthema, thrombocytopenia and in one patient signs of haemoconcentration. Initially both patients were treated with antibiotics. They recovered after intravenous fluid therapy; one of them received a thrombocyte transfusion. Increasing travel to Asia and South America will result in more tourists returning with this potentially serious arboviral disease (dengue haemorrhagic shock).     

SUNCT: bilateral hypothalamic activation during headache attacks and resolving of symptoms after trigeminal decompression

Short-lasting unilateral neuralgiform headache with conjunctival injection and tearing (SUNCT) is a primary head-pain syndrome, which is often refractory to any medical treatment. Concerning the pathophysiology of SUNCT, hypothalamic involvement ipsilaterally to the pain has been suggested based on the clinical features and one functional imaging case report. Here we now report a new case with SUNCT and the concomitant cerebral activation pattern (fMRI) during the pain attacks. In addition to an activation of several brain structures known to be generally involved in pain processing, bilateral hypothalamic activation occurred during the pain attacks, arguing for a central origin of the headache. Interestingly, this patient became completely pain free after surgical decompression of the ipsilateral trigeminal nerve. We hypothesize that in this case with a central predisposition for trigeminal autonomic cephalgias, a peripheral trigger with ectopic excitation might have contributed to the clinical picture of SUNCT.     

Insulin-like growth factor binding protein-related protein 1 (IGFBP-rP1/mac 25) is reduced in human prostate cancer and is inversely related to tumor volume and proliferation index in Lucap 23.12 xenografts

BACKGROUND: In the prostate, insulin-like growth factor binding protein-related protein-1 (IGFBP-rP1/mac 25) appears to be decreased in cancer. Likewise, mice injected with prostate cells over-expressing IGFBP-rP1/mac 25 showed decreased tumor formation and tumor volume. METHODS: Immunohistochemistry was used to determine the presence of IGFBP-rP1/mac 25 in human prostate tissue and in LuCaP 23.12 prostate cancer xenografts. RESULTS: Immunoreactivity for IGFBP-rP1/mac 25 was detected in the cytoplasm and nuclei of benign prostate epithelium. Cancer cells also stained but the level of intensity was less than that observed in benign epithelium (P < 0.05). Within the stroma, peripheral nerves, and endothelial vessels reacted with IGFBP-rP1/mac 25 antibodies. IGFBP-rP1/mac 25 was also observed in the nuclei of LuCaP 23.12 cells. LuCaP xenografts with smaller tumor volumes demonstrated more staining, and larger tumor volumes had less staining (P = 0.0033, R = 0.610). There was also a significant inverse correlation between IGFBP-rP1/mac 25 levels in LuCaP 23.12 cells and the proliferative index, measured by percent of cells staining for 5-bromo-2'-deoxyuridine (Br-dU) (P = 0.0045, R = 0.594). CONCLUSIONS: IGFBP-rP1/mac 25 is present in normal prostate epithelium and is decreased in human prostate malignancy and higher IGFBP-rP1/mac 25 levels are associated with reduced tumor growth.