Evaluation of sonographically guided percutaneous core biopsy of renal masses

OBJECTIVE: Our objective was to determine the utility of sonographically guided percutaneous core biopsy to evaluate renal masses. MATERIALS AND METHODS: We conducted a retrospective analysis of our imaging-guided procedures from January 1999 to June 2001. We performed 26 sonographically guided percutaneous core biopsies of renal masses in 26 patients. From two to five specimens were obtained from a single mass in each patient using an 18-gauge automated biopsy system. We examined the patients' medical records, pathology results, and imaging studies. Core biopsy results were compared with surgical pathology (n = 6) or clinical follow-up (n = 20). RESULTS: All biopsies provided sufficient material for analysis. Biopsy findings were positive for malignancy in 19 (73%) of 26 masses. Histologic diagnoses included renal cell carcinoma were (n = 11), metastasis (n = 3), lymphoma (n = 2), and transitional cell carcinoma (n = 2). Specific cell type characterization could not be made on one biopsy, but the specimens were highly suspicious for malignancy. Biopsy revealed seven (27%) of 26 benign diagnoses: oncocytoma (n = 3), angiomyolipoma (n = 2), and fibrosis (n = 2). The average follow-up period for patients with benign diagnoses was 10 months. One case of surgically proven necrotic pyelonephritis was mischaracterized as fibrosis at core biopsy. Sonographically guided percutaneous core biopsy of renal masses showed a sensitivity of 100% and a specificity of 100% for the diagnosis of malignancy. The core specimens yielded a specific diagnosis in 92% (24/26) of masses. No immediate complications occurred after the procedure. One patient developed a pseudoaneurysm that presented 3 months after the biopsy. CONCLUSION. Sonographically guided percutaneous core biopsy is a reliable and accurate method for evaluating renal masses.     

Localized muscular mucormycosis in a child with acute leukemia

Mucormycosis is a rare fungal infection of childhood, occurring mainly in patients with chronic illnesses such as diabetes and malignancies. The fungus seldom grows in culture and confirmation of the diagnosis depends on histologic examination of infected tissues. To date, the reported natural history of the disease has been rapid progression and a fatal outcome. Therefore, the importance of early diagnosis by tissue biopsy and early treatment with surgical debridement and systemic antifungal therapy cannot be overemphasized. The pulmonary system is the most common site for mucormycosis in patients with leukemia. We report what we believe to be the first successfully treated case of isolated muscular mucormycosis occurring in a child with biphenotypic acute leukemia. The diagnosis was made promptly by tissue examination at the time of surgical debridement. The patient was also given systemic amphotericin-B therapy.      

A sequence-specific polymerase chain reaction assay for mitochondrial DNA polymorphisms in human platelets and white cells

BACKGROUND: Because mitochondria are abundant in white cells and are also present in platelets, polymorphic sequences in mitochondrial DNA (mtDNA) represent a unique target for polymerase chain reaction (PCR)- based detection of donor material. STUDY DESIGN AND METHODS: A PCR assay was developed that uses sequence-specific primers (SSP) focused on two continent-specific mtDNA polymorphisms. Results were validated by the use of informative restriction endonucleases. Three commercially available methods to extract mtDNA from white cell-reduced human platelets was compared. In preparation for in vivo studies, in vitro mixing studies designed to mimic transfusion were conducted to investigate the performance of the SSP-PCR assay. RESULTS: The gene sequences of two representative examples of amplicons obtained with the new SSP-PCR matched the sequence expected from the published genetic code. Fifteen individuals were classified as either positive (n = 6) or negative (n = 9) for the Asian polymorphism by the use of published primers known to flank the polymorphic site followed by digestion with appropriate restriction enzymes. Results with SSP-PCR were nearly perfectly concordant with those of restriction enzyme analysis. Although the use of three DNA extraction methods allowed the preparation of mtDNA that was suitable for PCR, large and consistent differences (ranging from 10- to 1000-fold) in endpoint sensitivity were found. In vitro mixing studies reproducibly documented that the SSP-PCR assay could detect as little as 1 percent of donor platelets mixed with recipient blood. CONCLUSION: PCR-SSP can be reliably used to identify human mtDNA polymorphisms. By optimization of the method of mtDNA extraction, the sensitivity of PCR-SSP assay was greatly increased. This assay should prove useful in investigations of allogeneic platelet transfusions without cell labeling. It may also be applied to studies of the donor cell microchimerism that follows transfusion or transplantation.     

Roxatidine versus ranitidine in the treatment of duodenal ulcers: A randomized double-blind controlled multicentre study in Singapore

Roxatidine acetate, a new H₂ receptor antagonist, was compared with ranitidine in the treatment of duodenal ulcers in a double-blind multicentre study. Eighty-four patients with endoscopically proven duodenal ulcer were randomized to receive 150 mg roxatidine acetate or 300 mg ranitidine at bedtime. Repeat endoscopy was performed after 4 weeks (25–33 days) and if the ulcer had not healed, another endoscopy was performed after a further 4 weeks of treatment. Using per protocol analysis 73.6% of ulcers treated with roxatidine healed at 4 weeks compared to 72.2% of ulcers treated with ranitidine (P=NS). The healing rates at 8 weeks were 92% with roxatidine and 83.3% with ranitidine (P=NS). Using equivalence tests, the healing rate of roxatidine was found to be equivalent to that of ranitidine within a 20% region. Roxatidine users took significantly less antacids than ranitidine users (P < 0.05). There were no significant adverse effects due to roxatidine or ranitidine. Roxatidine is a safe effective drug in the treatment of duodenal ulcers with a healing rate comparable to that of ranitidine.     

The cost of steroid-free protocols in primary cadaver kidney transplantation

Steroid-free immunosuppression regimens have been enjoying recent success in clinical transplantation. The use of antibodies required for such protocols can be an economic burden. We proposed to study their cost in our center. This retrospective study involved 147 consecutive patients subjected to 4 protocols of immunosuppression. The first received triple therapy. The second group received induction with basiliximab, whereas the third received Basiliximab plus cyclosporine (CSA) plus mycophenolate mofetil (MMF), and the fourth received Thymoglobulin plus CSA plus MMF in conjuction with only 4 days of steroid. Rejection episodes were treated with Solumedrol. Six-month charges were obtained from computerized records of the finance department, the in-house laboratories, and the transplantation service registry. All charges were expressed in 2004 dollars. Statistical analyses were obtained using chi-square, analysis of variance (ANOVA) and Kaplan-Meier tests. The 4 groups were similar with regard to donor and/or recipient gender, race, panel reactive antibodies, cold ischemia, dialysis requirements length of stay and readmission, graft survival, and function. Charges were significantly higher in the last 2 groups as compared with triple therapy.     

Thoracic wall involvement by Hodgkin disease and non-Hodgkin lymphoma: CT evaluation

Thoracic computed tomographic (CT) scans of 250 patients with newly diagnosed or recurrent lymphoma revealed thoracic wall involvement in 24 patients (11 with Hodgkin disease, 13 with non-Hodgkin lymphoma). Thoracic wall involvement occurred without contiguous mediastinal or parenchymal involvement in 17 patients. Of these, 13 patients had masses beneath the pectoralis muscles or within the breast, and four had masses arising from the ribs. Five additional patients had mediastinal masses with thymic involvement and parasternal extension through the thoracic wall. Pulmonary parenchymal lymphoma with thoracic wall invasion was noted in the remaining two patients. In five of nine patients receiving radiation therapy, treatment plans were modified by CT demonstration of thoracic wall lymphoma.     

T2-weighted MR imaging in the assessment of cirrhotic liver

PURPOSE: To assess if T2-weighted magnetic resonance (MR) imaging provides added diagnostic value in combination with dynamic gadolinium-enhanced MR imaging in the detection and characterization of nodular lesions in cirrhotic liver. MATERIALS AND METHODS: Two readers retrospectively and independently analyzed 54 MR imaging studies in 52 patients with cirrhosis. In session 1, readers reviewed T1-weighted and dynamic gadolinium-enhanced images. In session 2, readers reviewed T1-weighted, dynamic gadolinium-enhanced, and respiratory-triggered T2-weighted fast spin-echo images. Readers identified and characterized all focal lesions by using a scale of 1-4 (1, definitely benign; 4, definitely malignant). Multireader correlated receiver operating characteristic (ROC) analysis was employed to assess radiologist performance in session 2 compared with session 1. The difference in the areas under the ROC curves for the two sessions was tested. In a third session, readers assessed conspicuity of biopsy-proved lesions on T2-weighted MR images by using a scale of 1-3 (1, not seen; 3, well seen) and identified causes of reduced conspicuity. RESULTS: Two additional benign lesions were detected by each reader in session 2. Fifty-five lesions had pathologic verification, including 32 malignant, three high-grade dysplastic, and 20 benign nodules. There was no significant difference in the area under the ROC curves between the two sessions (P =.48). Thirty-two lesions were inconspicuous on T2-weighted MR images because of parenchymal heterogeneity, breathing artifacts (particularly in patients with ascites), and lesion isointensity with liver parenchyma. T2-weighted MR imaging was useful in the evaluation of cysts and lymph nodes. CONCLUSION: T2-weighted MR imaging does not provide added diagnostic value in the detection and characterization of focal lesions in cirrhotic liver.