Anatomy of the hip: correlation of coronal and sagittal cadaver cryomicrosections with magnetic resonance images

Summary Magnetic resonance imaging (MRI) is noninvasive and provides images with higher soft tissue contrast than possible with any other imaging modality. Unlike CT which depicts anatomy in the axial plane, MRI is capable of producing images in thin cross sections acquired directly in any plane, usually axial, coronal or sagittal planes. The use of diagnostic MR images is facilitated by an understanding of the detailed anatomy that is depicted. The purpose of this study was to identify anatomical structures in coronal and sagittal cryomicrosections of the hip region. Thin cryosections of the hips of fresh-frozen cadavers were obtained by a method developed by one of the authors (WR). These sections were matched with thin-section, high resolution MR images of a normal volunteer. The complex anatomy of the hip and its surrounding muscles, tendons and ligaments was exquisitely depicted on both the cadaver microcryosections and the matched MRT images.

---

Anatomie de la hanche: corrélation entre les microsections et les résultats de l'imagerie en résonance magnétique

Résumé L'imagerie en résonance magnétique (IRM) est une technique non invasive qui permet d'obtenir des images des parties molles avec un contraste plus élevé que toutes les autres techniques. A la différence du scanner qui décrit l'anatomie dans le seul plan axial transverse, l'IRM est capable de donner des images en coupes fines obtenues directement dans n'importe quel plan: couramment dans les plan axial, transverse et sagittal. L'interprétation des images IRM est facilitée par la compréhension de l'anatomie détaillée de la région étudiée. Le propos de ce travail est d'identifier les structures anatomiques dans des plans de coupes sagittales et coronales de la région de l'articulation coxo-fémorale. Des coupes fines de pièces congelées ont été obtenues à partir de douze cadavres selon une méthode mise au point par l'un des auteurs (WR). Ces sections ont été comparées avec des coupes IRM fines faites en haute résolution chez un volontaire sain. L'anatomie complexe de la hanche et des muscles qui l'entourent ainsi que des tendons et des ligaments est décrite avec précision sur les coupes anatomiques et les images IRM.

     

胃恶性间质瘤合并继发性血小板增多症1例

胃恶性间质瘤患者1例,临床表现为继发性血小板增多症．手术后血小板数量恢复正常,血小板增多症可能是反应肿瘤负荷的重要指标．     

Immunoblot cross-reactivity of factor VIII inhibitors with porcine factor VIII

Porcine factor VIII has been used successfully to treat factor VIII inhibitor patients whose plasmas have minimal cross-reactivity to porcine factor VIII. However, some inhibitor plasmas do inhibit porcine factor VIII, and the extent of procoagulant inhibition often increases after treatment with porcine factor VIII. Because there is no information about the porcine factor VIII epitopes with which these antibodies react, we have compared the immunoblot and enzyme-linked immunosorbent assay (ELISA) reactivities with porcine and human factor VIII for 20 inhibitor plasmas (11 from hemophilia A patients and 9 autoantibodies). Immunoblots identified binding to porcine factor VIII for only 2 of the 12 plasmas from patients who had not received porcine factor VIII, but this reactivity could not be predicted from the inhibitor titer to porcine factor VIII. Immunoblot reactivity with porcine factor VIII was detected for 7 of 8 inhibitor plasmas from patients who had been previously treated with porcine factor VIII, and the strength of this reactivity was generally related to the inhibitor titer. Of the 5 plasmas that were immunoblot positive with the porcine factor VIII A2 domain, 4 had inhibitor titers greater than 45 Bethesda units when tested with porcine factor VIII, whereas only 1 of 15 of the other plasmas had this level of inhibitor activity with porcine factor VIII. In contrast, immunoblot reactivity to the porcine factor VIII A1 domain did not correlate with the antiporcine VIII inhibitor titer. We also determined the effect of preincubation with human or porcine factor VIII on immunoblot reactivity. In one case, immunoblot reactivity with porcine factor VIII was absorbed with porcine, but not human, factor VIII, which is consistent with antibody formation after treatment with porcine factor VIII. In no cases did human factor VIII reduce the reactivity of inhibitor plasmas with the porcine A1 domain, suggesting that these antibodies are directed at unique porcine factor VIII determinants. The reactivity to porcine A2 in 2 plasmas probably represented cross-reactivity of similar A2 determinants, because it was absorbed by both human and porcine factor VIII. Although the ELISA assays with porcine factor VIII detected antibodies in some plasmas that could not be identified by inhibitor assay or immunoblot, the level of ELISA reactivity was generally consistent with the titers of the other assays.     

应用电感耦合及射频理疗技术治疗骨延迟愈合骨不连

目的:已有临床经验证明应用电感耦合及射频理疗技术可以治疗骨延迟愈合骨不连,实验拟验证其诱导成骨及恢复骨连续性的效果。方法:选择2004-03/2007-03在河北医科大学第三医院住院进行手术治疗后发生骨不连接、骨延迟愈合的骨折患者50例,随机分为2组:实验组25例在常规治疗的基础上应用天津希统电子设备有限公司生产的XT-400A骨创伤治疗仪进行电感耦合治疗(60min/次,2次/d,30d为1个疗程),同时用北京凯士力电子有限公司生产的PWH-A型微波治疗仪进行射频理疗(15min/次,1次/d,30d为1个疗程);对照组行常规治疗。分别在治疗30,120d拍摄X射线片观察骨痂生长情况。结果:50例患者均完成治疗进入结果分析。在治疗30,120d时,实验组骨痂生长程度明显优于对照组(P<0.05),且无不良事件和副反应发生。结论:应用电感耦合及射频理疗技术诱导成骨及恢复骨连续性的效果确实可靠。     

Carotid dosimetry for T1 glottic cancer radiotherapy

Objective:

Radiotherapy for T1 glottic cancer is commonly delivered using a lateral parallel opposed pair of megavoltage photon fields. There is increasing reported evidence of cerebrovascular events due to radiation-induced carotid stenosis. An alternative field arrangement is to use an anterior oblique technique. This study compares the carotid dosimetry between the two techniques and reviews the evidence for the risk of radiation-induced vascular events.

Methods:

The radiotherapy plans of 10 patients with T1 glottic cancer treated with an anterior oblique technique were examined for carotid dose. Alternative plans were then created using a parallel opposed pair of fields and the dose to the carotids compared. All patients received 50 Gy in 16 fractions treating once daily, for 5 days in a week.

Results:

The average of the mean dose to the carotids with the anterior oblique technique was 21 Gy compared with 37 Gy using the lateral parallel opposed pair arrangement (p < 0.0001).

Conclusion:

An anterior oblique field arrangement for the treatment of T1 glottic cancer results in a significantly lower radiation dose to the carotid arteries, which may be clinically important in terms of reducing the risk of cerebrovascular events in long-term survivors.

Advances in knowledge:

Although the anterior oblique technique for treating early glottic cancers is well described, and it is predictable that the dose received by the carotid arteries should be lower with this technique, to our knowledge this is the first study to quantify that reduction in dose with a series of patients.For other than clearly defined vocal cord lesions clear of the anterior commissure, radiotherapy remains the mainstay of curative treatment for T1 glottic cancer.^1,2 The radiotherapy target volume should be confined to the larynx without any attempt to encompass neck nodes. There is increasing reported evidence of late cerebrovascular events such as transient ischaemic attacks and ischaemic strokes due to radiation-induced injury of the carotid artery, e.g. accelerated arteriosclerosis. These vascular events can occur many years after radiotherapy such that their relationship to previous radiotherapy is obscured.Classically, a lateral parallel opposed pair of megavoltage photon fields is used for the treatment of early glottic cancer. An alternative approach is an anterior oblique technique, which we adopted following the introduction of a linear accelerator in our centre in 1955 (Figure 1). We aim to assess the extent of carotid exposure, to compare the carotid dosimetry between anterior oblique and lateral parallel opposed pair techniques and also to review the evidence for the increased risk of vascular events.Open in a separate windowFigure 1.Diagram showing the anterior oblique field arrangement.     

Consequences of CT colonography in stenosing colorectal cancer

Background

In patients with stenosing colorectal cancer (CRC), visualization of the entire colon prior to surgery is recommended to exclude synchronous tumors. Therefore, most centers combine computed tomographic colonography (CTC) with staging CT. The aims of this study were to evaluate the yield and clinical implications of CTC.

Methods

In this multicenter retrospective study, patients with stenosing CRC that underwent CTC and subsequent surgery between April 2013 and November 2015 were included. Result of the CTC, its influence on the surgical treatment plan, and final histology report were evaluated.

Results

One hundred sixty-two patients with stenosing CRC were included. Nine (5.6 %) synchronous cancers proximal to the stenosing tumor were suspected with CTC. In four of nine patients, the CTC did not change the primary surgical plan because the tumors were located in the same surgical segment. In five of nine patients, CTC changed the surgical treatment plan. Three of these five patients underwent an extended resection and the presence of the tumors was confirmed. Two of these three synchronous CRCs were also visible on abdominal staging CT. In the other two patients, the result of CTC was false positive which led to an unnecessary extended resection in one patient.

Conclusion

The yield of CTC was relatively low. In only three patients (1.9 %), CTC correctly changed the primary surgical plan, but in two of them, the tumor was also visible on abdominal staging CT. Moreover, in two patients, CTC was false positive. The clinical value of CTC in stenosing CRC appears to be limited.