Coronary computed tomography–angiography quantitative plaque analysis improves detection of early cardiac allograft vasculopathy: A pilot study

Cardiac allograft vasculopathy (CAV) is an increasingly important complication after cardiac transplant. We assessed the additive diagnostic benefit of quantitative plaque analysis in patients undergoing coronary computed tomography–angiography (CCTA). Consecutive patients undergoing CCTA for CAV surveillance were identified. Scans were visually interpreted for coronary stenosis. Semiautomated software was used to quantify noncalcified plaque (NCP), as well as its components. Optimal diagnostic cut‐offs for CAV, with coronary angiography as gold standard, were defined using receiver operating characteristic curves. In total, 36 scans were identified in 17 patients. CAV was present in 17 (46.0%) reference coronary angiograms, at a median of 1.9 years before CCTA. Median NCP (147 vs 58, P < .001), low‐density NCP (median 4.5 vs 0.9, P = .003), fibrous plaque (median 76.1 vs 31.1, P = .003), and fibrofatty plaque (median 63.6 vs 27.6, P < .001) volumes were higher in patients with CAV, whereas calcified plaque was not (median 0.0 vs 0.0, P = .510). Visual assessment of CCTA alone was 70.6% sensitive and 100% specific for CAV. The addition of total NCP volume increased sensitivity to 82.4% while maintaining 100% specificity. NCP volume is significantly higher in patients with CAV. The addition of quantitative analysis to visual interpretation improves the sensitivity for detecting CAV without reducing specificity.     

Techniques in recurrent giant cell tumour of the first metatarsal in adolescents – A rare report of 2 cases

Giant cell tumour of the foot is very rare. Very few cases of first metatarsal giant cell tumour were reported. We report two cases of recurrent giant cell tumour in adolescent patients. One was treated with wide excision and fibula grafting. The second patient underwent Boyd's amputation because of superceded infection. Both had no pain, recurrence at the end of final follow up. Recurrent giant cell tumour of the first metatarsal in adolescents and its management is not described in English literature to the best of our knowledge.     

Computed tomography enteroclysis: a review

Computed tomography (CT) enteroclysis is being performed routinely for evaluation of suspected small bowel diseases. The availability of multidetector CT scanners has further increased the diagnostic yield of enteroclysis. There is excellent depiction of small bowel wall pathology on CT enteroclysis especially with use of negative enteric contrast. We discuss the CT enteroclysis technique and procedure along with the imaging spectrum of some common small bowel pathologies.     

Role of advanced 2 and 3-dimensional ultrasound for detecting prostate cancer

PURPOSE: We explored the clinical usefulness of spectrum analysis and neural networks for classifying prostate tissue and identifying prostate cancer in patients undergoing transrectal ultrasound for diagnostic or therapeutic reasons. MATERIALS AND METHODS: Data on a cohort of 215 patients who underwent transrectal ultrasound guided prostate biopsies at Memorial-Sloan Kettering Cancer Center, New York, New York were included in this study. Radio frequency data necessary for 2 and 3-dimensional (D) computer reconstruction of the prostate were digitally recorded at transrectal ultrasound and prostate biopsy. The data were spectrally processed and 2-D tissue typing images were generated based on a pre-trained neural network classification. We used manually masked 2-D tissue images as building blocks for generating 3-D tissue images and the images were tissue type color coded using custom software. Radio frequency data on the study cohort were analyzed for cancer probability using the data set pre-trained by neural network methods and compared with conventional B-mode imaging. ROC curves were generated for the 2 methods using biopsy results as the gold standard. RESULTS: The mean area under the ROC curve plus or minus SEM for detecting prostate cancer for the conventional B-mode and neural network methods was 0.66 +/- 0.03 and 0.80 +/- 0.05, respectively. Sensitivity and specificity for detecting prostate cancer by the neural network method were significantly increased compared with conventional B-mode imaging. In addition, the 2 and 3-D prostate images provided excellent visual identification of areas with a higher likelihood of cancer. CONCLUSIONS: Spectrum analysis could significantly improve the detection and evaluation of prostate cancer. Routine real-time application of spectrum analysis may significantly decrease the number of false-negative biopsies and improve the detection of prostate cancer at transrectal ultrasound guided prostate biopsy. It may also provide improved identification of prostate cancer foci during therapeutic intervention, such as brachytherapy, external beam radiotherapy or cryotherapy. In addition, 2 and 3-D images with prostate cancer foci specifically identified can help surgical planning and may in the distant future be an additional reliable noninvasive method of selecting patients for prostate biopsy.     

Non-01 Vibrio cholerae septicemia and meningitis in a neonate

Non-01 Vibrio cholerae is known to cause diarrhoea as well as extra-intestinal infections in adults and children. However meningitis in children is a rare occurrence. We report a neonate who developed septicemia and meningitis due toNon-01 Vibrio cholerae.     

Free fatty acids are associated with obesity, insulin resistance, and atherosclerosis in renal transplant recipients

BACKGROUND: Insulin resistance (IR) may be implicated in the pathogenesis of atherosclerosis in renal transplant recipients (RTRs) and be contributed to, in part, by free fatty acids (FFAs), produced in excess in centrally obese individuals. The aim of this study was to determine the prevalence of IR and the relationships between FFAs, central obesity, and atherosclerosis in a cohort of prevalent RTRs. METHODS: Observational data were collected on 85 RTRs (mean age 54 years; 49% male, 87% Caucasian). Fasting serum was analyzed for FFAs, glucose, and insulin; IR was calculated using the homeostasis model assessment (HOMA-IR) score. Vascular structure was assessed by carotid intima-media thickness (IMT) measurement. Linear regression analyses were performed to determine the factors associated with IR and atherosclerosis. RESULTS: IR occurred in 75% of RTRs, and FFA levels were independently associated with its occurrence (beta: -0.55, 95% CI: -1.02 to -0.07, P = 0.02). Other variables independently associated with IR were male sex, body mass index, central obesity, diabetes, systolic blood pressure and corticosteroid use. There was a significant correlation between FFA levels and IMT (r = 0.3, P=0.01). On multivariate analysis, IMT correlated with elevated FFA (beta: 0.07, 95% CI: 0.02-0.12, P = 0.007), diabetes mellitus (P = 0.05), older age (P < 0.002), and a body mass index >25 kg/m (P = 0.002). CONCLUSIONS: FFAs are associated with the development of IR and may be involved in the pathogenesis of atherosclerosis in RTRs. Additional studies are required to explore these associations further before considering whether an interventional trial aimed at lowering FFA would be a worthwhile undertaking.