Correlation between breast density in mammography and background enhancement in MR mammography

Purpose

We aimed to analyse the influence of mammographic breast density on background enhancement (BE) at magnetic resonance (MR) mammography in preand postmenopausal women. In addition, we questioned predictability of contrast-enhancement dynamics of normal fibroglandular tissue (NFT) at MR mammography according to mammographic breast density.

Materials and methods

Twenty-six patients (mean age 51.54±11.5 years; range 37–79 years) who underwent both MR mammography and conventional mammography were included in this retrospective study. Fourteen patients were premenopausal and 12 were postmenopausal. The ethics committee of our institution approved the study. The mammograms were retrospectively reviewed for overall breast density according to the four-point scale (I–IV) of the Breast Imaging Reporting and Data System (BI-RADS) classification. Two radiologists, who were unaware of the clinical data, separately assessed the MR mammography images. Images were assessed for enhancement kinetic features (enhancement kinetic curve and the early-phase enhancement rate) and BE. MR mammography and conventional mammography findings were compared according to BI-RADS breast density category and menopausal status.

Results

Percentage of increased signal intensity values during the first minute did not change according to mammographic breast density, and the mean early-phase enhancement rate scores were similar among breast density groups (p=0.942). There was no significant difference between pre- and postmenopausal groups. Enhancement kinetic features of the different groups based on BI-RADS breast density category and menopausal status were similar. There was no correlation between breast density and BE in either premenopausal (p=0.211) or in postmenopausal (p=0.735) groups.

Conclusions

We determined no correlation between mammographic breast density and so-called BE in MR mammography in either premenopausal or postmenopausal women. NFT at MR mammography cannot be predicted on the basis of mammographic breast density.     

Utility of serum and urine uPAR levels for diagnosis of breast cancer

Malignant tumors have a capacity to degrade the extracellular matrix by controlled proteolysis. One system involved in these processes is the urokinase-type plasminogen activator (uPA) system. uPAR levels are elevated in tumors from several types of cancer. Our study was planned to investigate serum and urine levels of uPAR in breast cancer patients (n=180) and healthy controls (n=60) by ELISA. Serum (p<0.001) and urine (p<0.001) uPAR values in the patients were both significantly elevated. High serum and urine levels of uPAR can be used as diagnostic tools in lymph node positive patients.     

Vaccine potential of recombinant saposin-like protein 2 against Fasciolosis gigantica in mice

Saposin-like protein 2 (SAP-2) is a protein that adult of Fasciola spp. use to lyse plasma membrane of red blood cells, so that their contents can be digested by proteases for the parasites’ nutrients. Thus SAP-2 is a plausible target for vaccination against these parasites. Recombinant Fasciola gigantica saposin-like protein 2 (rFgSAP-2) was expressed in Escherichia coli BL21 (DE3). A vaccination was performed in ICR mice (n = 10) by subcutaneous injection with 50 μg of rFgSAP-2 combined with Freund's adjuvant. At 2 weeks after the second boost, mice were infected with 30 F. gigantica metacercariae by oral route. The percentages of protection of rFgSAP-2 vaccine against F. gigantica were estimated to be 76.4–78.5% when compared with non vaccinated-infected and adjuvant-infected controls, respectively. The antibodies in immune sera of vaccinated mice were shown by immuno-blotting to react with native FgSAP-2 in the extract of 2- and 4-week-old juvenile parasites. By determining the levels of IgG1 and IgG2a in the immune sera, which are indicative of Th2 and Th1 immune responses, it was found that both Th1 and Th2 humoral immune response were significantly increased in rFgSAP-2 immunized group compared with the control groups, with higher levels of Th2 (IgG1) than Th1 (IgG2a). The levels of serum aspartate aminotransferase (AST) and alanine transaminase (ALT) in rFgSAP-2-immunized group showed no significant difference from those of the non-immunized and infected group, indicating that early juvenile parasites induced liver parenchyma damage, even though the numbers of worm recoveries were significantly different. This study indicates that rFgSAP-2 has a high potential as a vaccine candidate against F. gigantica in mice, and this potential will be tested in larger economic animals.     

Silent cerebral emboli following percutaneous closure of atrial septal defect in pediatric patients: a diffusion-weighted MRI study

PURPOSE

The aim of this prospective study was to investigate the incidence of silent cerebrovascular embolic events associated with percutaneous closure of atrial septal defect (ASD) in pediatric patients.

METHODS

A total of 23 consecutive pediatric patients (mean age, 10.4±3.8 years; range, 4–17 years) admitted for transcatheter closure of ASD were recruited in the study. The patients were scanned with a 1.5 Tesla clinical scanner. Two cranial magnetic resonance imaging (MRI) examinations were acquired before the procedure and within 24 hours following the catheterization. MRI included turbo spin-echo fluid-attenuated inversion recovery (FLAIR) sequence and diffusion-weighted imaging technique with single-shot echo-planar spin-echo sequence. The transcatheter closure of ASD was performed by three expert interventional cardiologists. Amplatzer septal occluder device was implemented for the closure of the defect. No contrast medium was administered in the course of the procedure.

RESULTS

None of the patients had diffusion restricted cerebral lesions resembling microembolic infarctions on postprocedural MRI. Preprocedural MRI of two patients revealed nonspecific hyperintense white matter lesions on FLAIR images with increased diffusion, which were considered to be older ischemic lesions associated with previously occurred paradoxical embolism.

CONCLUSION

The current study suggests that percutaneous closure of the ASD, when performed by experienced hands, may be free of cerebral microembolization in pediatric patients. However, due to the relatively small sample size, further studies with larger patient groups are needed for the validation of our preliminary results.Acute symptomatic cerebral infarction associated with percutaneous cardiovascular intervention has been reported to have an incidence of 0.09%–1.0% when evaluated solely with neurologic examination (1–4). However, asymptomatic cerebral microemboli detected with transcranial Doppler ultrasonography (US) monitoring and diffusion-weighted imaging (DWI) following either conventional or interventional cardiac catheterization is unexpectedly more common (4–10). The incidence revealed with DWI studies varies between 3.3% and 77% depending on risk factors associated with the patient population and the procedure, in adult studies (9, 10).Due to technologic developments, more children with congenital heart disease are taken to the cardiac catheterization laboratory for interventional treatment. The subclinical focal neurologic events are more difficult to reveal solely with neurologic examination in children compared with the adult age group. Therefore, it is crucial to determine the silent neurologic complications and the risk factors associated with heart catheterization in the pediatric population. There have been a few studies in adults (10–12), but to the best of our knowledge, no clinical studies revealed the association of subclinical ischemic lesions with transcatheter closure of atrial septal defect (ASD) in pediatric patients.Transcatheter closure of ASD, which is an alternative to open heart surgery, is applied as a first-line treatment modality in appropriate patients (13). Despite increasing rates of complete closure with ongoing technologic innovations, neurologic complications associated with peri-interventional cerebral embolism have been reported (10, 11). In this single-center, prospective study, we aimed to investigate the incidence and the risk factors of silent cerebral embolism following transcatheter closure of ASD with the Amplatzer septal occluder (AGA Medical Corp.) device in pediatric patients.     

Chronic otitis media with effusion and Helicobacter pylori

OBJECTIVE: The aim of this study is to investigate the presence of Helicobacter pylori (HP) in the middle ear effusion by Campylobacter-like organism (CLO) test and whether it has a role in the ethiopathogenesis of chronic otitis media with effusion (OME). STUDY DESIGN: A prospective randomized and controlled study. METHODS: This study was performed with 45 patients with the diagnosis of chronic OME and adenoid hypertrophy, between the ages 3 and 13 (median 6). Thirty patients constituted the study group (18 male (60%) and 12 (40%) female). Adenoidectomy with myringotomy with ventilation tube insertion were performed to this group. Middle ear effusion and adenoid tissue pieces were collected and H. pylori presence was investigated by "CLO" testing. Fifteen patients of the matching age group (9 male (66.7%) and 6 (33.3%) female) constituted the control group to whom adenoidectomy with myringotomy were performed but no middle ear effusion could be determined (empty myringotomy patients). The wash out liquid of middle ear and pieces of adenoid tissue samples were also collected from the control group. By using CLO testing, the presence of H. pylori was investigated in the adenoid tissues and middle ear of the empty myringotomy patients. RESULTS: In 20 (66.6%) patients of the study group, CLO testing was positive in the middle ear effusions. None of the patients demonstrated positive CLO test in the wash out liquid of middle ear. There was significant difference of positive CLO testing in the middle ear effusions of two groups (p<0.001). CONCLUSIONS: These findings showed us that presence of HP in the middle ear effusion using CLO testing and this may be responsible for the ethiopathogenesis of chronic OME.     

Human papillomavirus DNA in plasma of patients with cervical cancer

Background  

Human papillomavirus (HPV) is a crucial etiological factor for cervical cancer (CC) development. From a diagnostic view-point, the consistent presence of HPV in CC allows the viral DNA to be used as a genetic marker. The aims of this study were to evaluate the presence, physical status and clinical significant of HPV DNA in circulation of CC patients.