MRI of Gynaecological Solid Masses: Pictorial Review

Differential diagnosis of gynaecological masses is sometimes difficult, as there are so many histological types. However, magnetic resonance characteristics of some gynaecological tumours have been reported past several years. On the basis of the recent literature, we have made a decision tree for differential diagnosis of solid gynaecological tumours, in which there are some important divergences. Bilateral disease and invasive growth are malignant signs in most cases. Specific findings for different tumour types include: fibrovascular septa in dysgermonimas; preserving ovarian follicles in round cell tumours; pseudolobular patterns in young patients in sclerosing stromal tumours; and extremely hypointense masses on T2WI in Brenner tumours. Distinguishing between sex-cord stromal tumours, Brenner tumours and metastatic tumours may be hard, however, especially in middle age, because they all tend to show well-demarcated, hypointense masses on T2WI. Disproportionately clear zonal anatomy of the uterus, enlarged uterus and thickened endometrium, which are indirect findings of oestrogen-producing tumours, are useful diagnostic findings in children and postmenopausals.Tanaka, Y. O. (2000). Clinical Radiology55, 899–911.     

Efficacy of photodynamic therapy with topical 5‐aminolevulinic acid using intense pulsed light for Bowen’s disease

Photodynamic therapy (PDT) with topical 5‐aminolevulinic acid (ALA) is reported to be an effective and safe treatment for superficial non‐melanoma skin cancers. We have developed an photodynamic therapy with topical δ‐aminolevulinic acid (ALA‐PDT) protocol using intense pulsed light (IPL) for treating Bowen’s disease (BD). Three patients diagnosed with BD by skin biopsy were recruited in this study. They received IPL treatment after 3 h of occlusive dressing with application of ALA. This protocol was repeated every 2 weeks for a total of five sessions. The treated areas did not show any signs of BD for more than 1 year; therefore, it appeared that the affected areas showed improvement in all the patients. No patients withdrew from the study because of side‐effects. ALA‐PDT with IPL as a light source is well tolerated by patients and is beneficial for treating BD.     

Ambulatory Urodynamics in Asymptomatic,Young, Healthy Male Volunteers

Objectives: To assess the incidence of detrusor overactivity and reproducibility of data from ambulatory urodynamic monitoring (AUM) in male volunteers. Methods: Sixteen asymptomatic healthy male volunteers with a mean age of 26.3 years (range: 22–30) underwent AUM by natural filling cystometry followed by a pressure/flow study. The studies were repeated three times. Results: Detrusor overactivity (DO) was detected in six subjects (37.5%), but clinically significant detrusor overactivity was noted only in three (18.8%). Q_max, detrusor opening pressure, and P_detQ_max were similar among the three measurements. The bladder outlet obstruction index (BOOI) varied, and there was a significant difference between the first and third measurements (P = 0.0371). Obstruction grade was ranked as unobstructed in all studies for 13 subjects, equivocal (BOOI 45 and 46) in one subject, and both unobstructed and equivocal (BOOI 30, 43 and 30) in one subject. There was a significant difference in bladder contractility index (BCI) between the first and third studies (P = 0.0186). The BCI was always strong in five subjects, always normal in eight subjects, and strong to normal in three subjects. Conclusion: DO was found in 37.5% of male volunteers. BOOI and BCI may not be highly reproducible, and the third study may provide the best result if the first and second studies differ. However, 87.5% of subjects were rated as unobstructed and all subjects were rated as normal or strong, with the categories of obstruction and bladder contractility showing no change in most subjects. AUM with three studies seem adequate for the evaluation of lower urinary tract dysfunction in males.     

Telomerase activity is correlated with lower grade and lower stage bladder carcinomas

BACKGROUND: Telomerase is a ribonucleoprotein enzyme that compensates for the progressive erosion of telomeres. The increasing interest in telomerase is motivated by the demonstration that most human carcinomas are telomerase positive. The potential use of telomerase activity in bladder carcinomas using a urine sample has been reported in several studies. However, little is known about the detection of telomerase activity in bladder carcinoma tissues. Herein, we investigate telomerase activity in bladder carcinoma tissues according to grade (G) and stage. MATERIAL AND METHODS: Telomerase activity was assayed by polymerase chain reaction enzyme-linked immunosorbent assay methods. Malignant lesions were assessed in 37 patients with bladder carcinoma and no malignant lesions were assessed in five patients with dysplasia or inflammatory bladder lesions. RESULTS: Twenty-three out of 37 carcinoma samples were telomerase-positive and one out of five control samples without carcinoma was telomerase-positive. The positive rates according to stage and grade were 83.3% for superficial and 42.1% for invasive stages and 83.3% for G1, 66.7% for G2 and 40.0% for G3. Telomerase activity was correlated with lower grade and lower stage bladder carcinomas. CONCLUSION: These results strongly suggest that reactivation of telomerase may differ between superficial and invasive bladder carcinomas and also between low grade and high grade bladder carcinomas.     

Relationship between behavioral disturbances and characteristics of patients in special units for dementia

Abstract The aim of the present study was to examine the relationships between behavioral disturbances and patient characteristics of inpatients with dementia nationwide. The five patient characteristics used were age, gender, years of education, cognitive status, and walking ability. The subjects consisted of 730 inpatients selected by systematic sampling from 180 units that have specialized psychiatric beds for acute/long‐term care of dementia. Clinical staff members assessed the 730 patients with the Mini‐Mental State Examination (MMSE), and filled out a questionnaire for long‐term care insurance, including 19 items relating to behavioral disturbances and walking scale. Five meaningful factors were identified out of the 19 behavioral disturbances by factor analysis. Linear regression analysis revealed that the factor ‘psychotic/neurotic’ was not related to any patient characteristics; ‘aggression/negativistic’ was related to male gender and a lower MMSE score; and ‘dirty/destructive’ and ‘disorientation/fire management’ were related to a lower MMSE score and higher walking score. The factor ‘sexual behavior’ included only one behavior at a very low frequency. These findings suggest that different behavioral disturbance factors have different correlations with patient characteristics, while cognitive dysfunction has a relatively important role in behavioral disturbances of inpatients with dementia.     

A Nodule-aggregating Lesion of the Rectum Associated with Gastric Adenoma —A Case Report—

Abstract: A 81-year-old female was admitted to our hospital to undergo endoscopical treatment for a gastric adenoma and received YAG-laser therapy. The gastric adenoma was completely removed by laser therapy. However, following treatment, she complained of having mucous feces. Although she had undergone a colonoscopy twice during the previous six month, we examined her large intestine using colonoscopy and barium enema. A colonoscopy revealed a large-flat elevated lesion of the same color as the surrounding mucosa and no transmucosal vascularity of the rectum. A well demarcated flat lesion 4 cm in size with conglomerated nodules on its surface was confirmed using the dye-spraying contrast method with 0.2% indigo carmine solution. A lower anterior resection of the rectal lesion was performed and the patient is now living and well 16 month following surgery. We believe that, if we encounter gastric adenomas, more careful observation and use of the dye-spraying contrast method are necessary for the detection of adenomas or cancers in the colon.     

Spinal tract degeneration confined to the bilateral posterior columns in malnutrition: Report of an autopsy case

Abstract An autopsy case of malnutrition with spinal tract degeneration confined to the bilateral posterior columns is reported. The patient had schizophrenia in adolescence, and suffered from aplastic anemia in late middle age. Subsequently, he took little food due to delusions for 18 months until his death. He had malnutrition resulting in severe hypoproteinemia. He developed gait disturbance, loss of deep tendon reflexes and paresthesia of limbs. Neuropathological examination disclosed tract degeneration confined to the bilateral spinal posterior columns, in addition to the findings of aplastic anemia and hypoxic encephalopathy in the cerebrum. The myelin and axons were severely affected throughout the spinal cord; status spongiosus with many fatty-laden macrophages was seen in these lesions. Neurons in the posterior column nuclei were intact, while the dorsal roots and their ganglia were moderately affected. The unusual distribution and extension of the degeneration of the bilateral posterior columns in the poor nutritional state is discussed.