Accuracy of fine needle aspiration cytology in the diagnosis of bone lesions with radiological assistance: Experience from the National Cancer Institute,Cairo University,Egypt

Aim

To evaluate the accuracy of fine needle aspiration cytology in the diagnosis of bone lesions with radiological assistance.

Patients and methods

85 cases of FNAC of bone lesions were included. Sixty two procedures were performed by the radiologist and 23 procedures by the histopathologists. The aspirates were immediately fixed in 95% ethanol alcohol for Papanicolaou staining. If there was sufficient material, cell block was prepared. Diagnosis was established in 81 cases (95.3%), classified into 3 categories: (1) positive for malignant cells (57.6%); (2) suspicious for malignant cells (10.6%); and (3) benign, borderline or inflammatory lesions (27.1%). Cytology findings were compared with subsequent available histology.

Results

The overall accuracy was 91%. The 49 cases diagnosed as malignant by cytology were all correct. FNAC could differentiate various giant cell rich lesions and round cell malignancies as Ewing’s sarcoma, myeloma and NHL. Uncommon bone lesions as chordoma and MFH were also correctly diagnosed. Cytological diagnosis of benign and borderline lesions was made in 23 patients. The authors encountered difficulties diagnosing a case of MFH that was reported as osteosarcoma and a case of metastasis that was reported as chondrosarcoma.

Conclusion

FNAC of bone lesions is a simple, safe and accurate diagnostic technique for diagnosis of bone lesions especially when other diagnostic modalities are unavailable.     

Hippocampus,caudate nucleus and entorhinal cortex volumetric MRI measurements in discrimination between Alzheimer’s disease,mild cognitive impairment,and normal aging

Background

Structural neuroimaging MR volumetric changes can predict progression of MCI to AD. Early effective treatment of MCI has been shown to delay institutionalization and improve cognition and behavioral symptoms.

Aim of the work

To evaluate the role of volumetric MRI to identify a pattern of regional atrophy characteristic in differentiation between Alzheimer’s disease, Mild Cognitive Impairment, and Normal elderly control.

Material and methods

The regional ethics committee approved the study and written informed consent was obtained from all participants. Between April 2012 and May 2013, prospective study was conducted on 25 patients (18 males and 7 females) and 15 healthy elderly controls (9 males and 6 females) referred to the Radiodiagnosis Department from the Neuropsychiatry Department that had clinical manifestations of suspected cognitive impairment, we used the Mini Mental State Examination (MMSE) as a measure of general cognitive function and the total learning from the Auditory Verbal Total Learning Test (AVTOT) as a measure of memory performance. One year follow up of patients was done to assess the disease progress.

Results

Twenty-five patients were included in this study {Alzheimer disease (10 cases), MCI (15 cases)} and 15 healthy elderly controls. Mean MMSE scores were significantly lower in patients with Alzheimer’s disease compared with MCI and control cases (P < 0.001). Positive correlation (except left caudate nucleus) between gray matter volume reduction in MCI and AD in relation to elderly control and MMSE score was observed. The Auditory Verbal Learning Test (AVTOT) was significantly lower in patients with Alzheimer’s disease compared with MCI and control cases (P < 0.001). No significant differences were found between groups as regards age, sex, education or dominant hand. Significant gray matter volume reductions were found in both AD and MCI compared to healthy elderly control however no significant differences were found among MCI patients or AD patients. Sensitivity, specificity, PPV and NPV of caudate nucleus and hippocampal volume reduction in AD and MCI in relation to elderly control were higher than entorhinal cortex.

Conclusion

Semi-automated MR volumetric measurements can be used to determine atrophy in hippocampus, caudate nucleus and entorhinal cortex which aided in discrimination of healthy elderly control subjects from subjects with AD and MCI and predict clinical decline of MCI leading to increase the efficiency of clinical treatments, delay institutionalization and improve cognition and behavioral symptoms.     

Transhepatic venous catheters for hemodialysis

Purpose

To describe our experience with the technique of transhepatic venous access for hemodialysis and to evaluate its functionality and complications.

Patients and methods

From March 2012 till October 2012, 23 patients with age ranging from 12 to 71 years old having end-stage renal disease (ESRD) were included in our study and were subjected to transhepatic venous catheter insertion. In 21 patients there were not any remaining patent peripheral venous accesses. In 2 patients there were only a last one venous access needed to be preserved. Thus, it was decided to make THVA. In all the 23 patients the indication was palliative due to inoperability which was because of inability to insert an arterio-venous graft or making another arterio-venous fistula. Complications were evaluated and calculated in terms of number of procedures, infection, dislodgement and outcome; in terms of disfunctionality of the catheter.Follow-up was performed by monitoring the catheter dialysis rate in each session, abdominal ultrasonography, fluoroscopy or CT. Mean survival time and median survival time from the start of treatment were calculated using Kaplan–Meier method.

Results

Twenty-three patients required a single transhepatic access procedure. Because of catheter dislodgment, two patients required a second access placement procedure, which resulted in a total of 25 separate transhepatic access sites in 23 patients. Technical success was achieved in 22 procedures. Functionality success was achieved in 20 patients. Functionality failure occurred in 3 patients.The trans-hepatic catheters stayed in place between 90 and 300 days. Complications occurred in 14 patients.

Conclusion

Based on our findings, transhepatic hemodialysis catheters have proven to achieve good long-term functionality. A high level of maintenance is required to preserve patency, although this approach provides remarkably durable access for patients who have otherwise exhausted access options.     

Prediction of short term outcome of pulmonary embolism: Parameters at 16 multi-detector CT pulmonary angiography

Purpose

To evaluate the accuracy of computed tomography pulmonary angiography (CTPA) parameters, for predicting short-term mortality in patients with acute pulmonary embolism (PE).

Materials and methods

Thirty-two patients with proven PE had CT pulmonary angiography were included in the study. The clot burden using the Qanadli score (QS), and the right ventricular dysfunction (RVD) parameters were assessed on CT by calculating right ventricular/left ventricular (RV/LV) diameter ratios, interventricular septum abnormality, inferior vena cava contrast reflux, azygous vein and superior vena cava measures. Contrast density in pulmonary artery and descending aorta was evaluated for all patients. Patients were followed up for 30 days and then classified as survivors or non survivors.

Results

Thirty-two patients were included in the study, 23 (71.8%) of them were classified as survivors, and the other nine (28.1%) patients died within the first month (non survivors). There was a positive, but weak correlation between the Qanadli score and the short term mortality (P value = 0.05). There was a statistically significant relationship between the RV/LV ratio and PE-related mortality, with a P value < 0.001. Also, there was a good correlation between degree of IVC reflux and PE outcome (P < 0.001). The PA/AO diameter ratio, SVC diameter and azygous vein diameter showed no statistically significant difference between survivors and non survivors.

Conclusions

CTPA findings that may predict short term mortality are the high grades of inferior vena cava reflux, RV/LV diameter ratio more than 1.2, and clot burden >18 according to the Qanadli score and to a lesser degree the interventricular septum abnormality.     

Acute and chronic mesenteric ischemia: Multidetector CT and CT angiographic findings

Aim of the work

To assess the role of multidetector CT (MDCT) and CT angiography (CTA) in the diagnosis of acute and chronic mesenteric ischemia.

Patients and methods

This prospective study was performed on 57 consecutive patients clinically suspected of having mesenteric ischemia, they were examined with 16-row multidetector CT, MDCT and CTA were evaluated for evidence of bowel wall changes and abnormal mesenteric vascular changes.

Results

Twenty one patients of studied 57 patients had an abnormal CTA finding diagnostic of mesenteric ischemia and they constituted the material of this study, the most prevalent MDCT findings were bowel wall thickening, bowel distension and non-enhanced bowel wall. MDCT and CTA gave an accurate diagnosis of the cause of mesenteric ischemia as proved by the final diagnosis based on surgical exploration, conventional angiography, laboratory investigations and clinical follow up with 100% sensitivity and specificity.

Conclusion

MDCT and CTA are fast, safe, accurate and non-invasive imaging modalities of choice in patients with suspected mesenteric ischemia which are able to evaluate not only mesenteric vascular structures but also evaluate bowel wall changes and adjacent mesentery, thus detecting the primary cause of mesenteric ischemia that can lead to earlier diagnosis and intervention.     

Diffusion tensor imaging of periventricular leukomalacia – Initial experience

Aim of the study

To investigate the role of MR diffusion tensor imaging (DTI) and diffusion tensor tractography (DTT) in the assessment of altered major white matter fibers in preterm infants and children with PVL.

Patients and methods

We used diffusion tensor imaging to evaluate the major white matter tract fibers in 15 children with periventricular leukomalacia in correlation with cognitive and motor disability. Mean age of the patients was 28.5 months (range: 9–84 months). 5 normal control children were recruited (mean age: 21.4, range: 11–60 months). MR imaging was obtained by using a 1.5-T, whole-body scanner. DTI was acquired after the routine sequences. Then, data post-processing and fiber-tracking method was applied.

Results

This study demonstrated the existence of the WM tract injury in PVL patients using the DTI tractography approach in correlation with neurodevelopmental delay in patients with various degrees of cognitive and motor impairment. Compared with the normal control group, the following abnormalities were detected on qualitative analysis of the white matter tracts.

Corticospinal tracts

Decreased volume and cross-sectional area on the affected side.

Ascending sensorimotor tracts

Thinning of sensory fiber tracts and posterior thalamic radiations.

Commissural and association tracts

Significant damage of the callosal fibers was reported in cases with partial agenesis of the corpus callosum.

Conclusion

DTI proved to be a promising noninvasive method for assessing the severity of white matter tract injury in patients with PVL. This is owing to the capability of fiber-tracking techniques to provide more information for understanding the pathophysiologic features of sensorimotor and cognitive disability associated with PVL. This will allow for the early intervention and initiation of rehabilitation programs aiming for minimizing the associated neurological deficit.     

Purification and partial characterization of paralytic shellfish poison-binding protein from Acanthocardia tuberculatum.

A paralytic shellfish poison-binding protein (PSPBP) was purified 16.6-fold from the foot of the Moroccan cockles Acanthocardia tuberculatum. Using affinity chromatography, 2.5mg of PSPBP showing homogeneity on sodium dodecyl sulfate-polyacrylamide gel electrophoresis (SDS-PAGE) was obtained from 93 mg of crude extract. The purified PSPBP exhibits a specific activity of about 2.78 mU/mg proteins and has estimated molecular weight of 181 kDa. Observation of a single band equivalent to 88 kDa on SDS-PAGE under reducing conditions suggested it to be a homodimer. The optimal temperature and pH for the purified PSPBP were respectively 30 degrees C and 7.0.     

Cyanobacteria and their toxins in treated-water storage reservoirs in Abha city, Saudi Arabia.

Occurrence of toxic cyanobacteria in drinking and recreational waters poses human health at risk as they can release potent toxins into the water. In the present study, open and covered treated-water storage reservoirs as well as their relevant tap waters in Abha city, Saudi Arabia, were surveyed for the presence of cyanobacteria and their toxins. The results revealed the contamination of most open reservoir and tap waters by algae and cyanobacteria, with an abundance of toxigenic species of cyanobacteria. Depending on the results of the Limulus amebocyte lysate (LAL) assay and enzyme linked immunosorbent assay (ELISA), endotoxins and microcystins (MCYSTs) were found in most open reservoir and tap waters at concentrations up to 32EUml(-1) and 0.3mugml(-1), respectively. The extracts of axenic cultures of most cyanobacterial species isolated from these reservoirs showed activity to LAL assay, with large endotoxin amounts obtained in Calothrix parietina (490EUg(-1)) and Phormidium tenue (210EUg(-1)). Based on ELISA and HPLC analysis for these extracts, only C. parietina can produce MCYSTs (202mugg(-1)) with a profile consisting of MCYST-RR and -LR. This study suggests that open treated-water storage reservoirs should be covered to prevent the presence of cyanobacteria and their toxins in such drinking and recreational waters.