Prevalence of elevated serum prostate-specific antigen in rural Nigeria

BACKGROUND: Recent hospital and cancer registry data show increasing prostate cancer incidence in Nigeria, which was previously regarded as a low incidence region. This study investigates the prevalence of prostate cancer risk in a previously unscreened cohort of rural Nigerians. METHODS: Rural Nigerian men, 40 years and older, were screened by serum prostate-specific antigen (PSA) and digital rectal examination (DRE) and those with PSA >/= 4 ng/mL and/or abnormal DRE were referred for prostate biopsy. RESULTS: Of 200 consecutive men invited, 151 (75.5%) presented for screening, the mean age was 56.45 + 15.1 and 95 (61.6%) were >/= 50 years of age. Of the 140 who consented to a blood test, PSA correlated with age (r = 0.3, P < 0.01), 14 (10.0%) had abnormal PSA >/= 4 ng/mL, increasing from 3 (3.6%) in men < 60 years to 4 (50%) in men >/= 80 years. The rate was 13 (15.7%) for men >/= 50 years and there was no evidence of increased incidence of prostatitis in the community. Mean (median) PSA in ng/mL increased from 1.17 (0.60) in the youngest to 13.75 (4.45) in the oldest cohort. Of those who accepted DRE, 38 (29.0%) had an enlarged prostate, including two who had nodular prostate, one-third with symptoms, increasing from 4 (5.4%) in those < 50 years to 6 (75.0%) in men >/= 80 years. The proportion of men with PSA >/= 4 ng/mL among those with enlarged vs normal prostate is 27.0 to 3.4%, P < 0.001, and the pattern was similar for men >/= 60 years and those < 60 years of age. The 40 (32.0%) men referred for prostate biopsy defaulted mainly because they did not fully understand the need for further investigation because they were symptom free or afraid of the possible side-effects of the procedure or diagnosis of cancer. CONCLUSION: The proportion of men with PSA >/= 4 ng/mL is comparable to that of previously unscreened populations with high incidence of prostate cancer such as African-American men. A larger study is required to confirm these findings and intensify efforts to determine the prostate cancer detection rate by biopsy in this population. A prostate cancer awareness and education campaign will be useful in this community.     

Le sommeil de l’analyste

The state of “nodding off” which the psychoanalyst may experience during therapy is a phenomenon that requires further investigation into its nature, causes, and effects. Even if it occurs only sporadically and is a physiological necessity, it nevertheless has a certain effect and can present certain advantages. This introduction of resistance in the form of sleep can sometimes provide an opportunity in the development of sensorimotor functions for the patient to verbalize his experience, and in any case this phenomenon should not be taken lightly. Recourse to current knowledge regarding sleep can improve our understanding of this phenomenon, and we should be prepared to take the risk of examining psychoanalysis on the basis of a non-analytical approach, i.e. primarily psychobiological and cognitive. This also permits a link to be made between the psychoanalyst’s therapeutic activity and the contextual phenomena which influence cerebral activity and its level of vigilance which is expressed by specific types of verbalization. The pertinence of this risk-taking should also be examined, and a distinction made between physiologically necessary somnolence and other causes. It appears that in the present context, the induction of a state of somnolence is caused by the narcissistic characteristics of a transferential relation that is in the process of development; that is to say, the “positive aspects’’ of narcissism, which are an integral part of psychic growth. However, we should also bear in mind that these narcissistic characteristics can also be expressed in the form of resistance.     

Simple Partial Status Epilepticus Localized by Single-Photon Emission Computed Tomography Subtraction in Chronic Cerebral Paragonimiasis

A patient with chronic cerebral paragonimiasis began to have new motor seizures of the right face manifested by clonic contractions that occurred several hundred times a day, consistent with simple partial status epilepticus. Ictal electroencephalogram discharges started from the left frontal region and then spread to the left hemisphere with left frontal maximum. But clinical seizures were limited to the right face. The frequent partial seizures were controlled by the intravenous infusion of phenytoin. Brain magnetic resonance imaging showed multiple conglomerated round nodules with encephalomalacia in the left temporal and occipital lobes. Applying the technique of ictal-interictal single-photo emission computed tomography subtraction, the authors were able to localize the focal ictal-hyperperfusion on left precentral cortex adjacent to the lesions that correspond to the anatomical distribution of left face motor area.     

Position as a variable for cardiovascular responses during exercise

Twenty-one normal young male subjects underwent resting and exercise (bicycle) radionuclide angiography in the full supine and 70 degrees upright tilt positions in order to examine the effects of position on left ventricular size and performance, hemodynamics, and exercise duration. All subjects also underwent full (90 degrees) upright bicycle ergometry with respiratory gas analysis to establish the level of maximal exercise capacity for each. Body position significantly (p less than 0.05) affected resting and exercise cardiovascular parameters. End-diastolic and endsystolic left ventricular volumes and stroke volume were larger in the supine position, both at rest and during exercise. The cardiac output at rest and during exercise were comparable for the two positions; an increase in resting and exercise heart rate in the 70 degrees tilt position compensated for the reduced stroke volume of this posture. At maximal exercise, the 70 degrees upright position was associated with a greater response in left ventricular ejection fraction, otherwise this parameter was not position related. Exercise capacity, in terms of duration and workload, was significantly higher in the supine (1870 +/- 390 s) and full upright (1830 +/- 250 s) positions than in the 70 degrees tilt position (1730 +/- 260 s). Changes in body position significantly alter parameters of ventricular, cardiovascular, and exercise performance.     

烟雾病11例临床分析

自１９８５年至今，我院收治１１例经脑血管造影诊断的烟雾病患者。按照日本厚生省本病诊断标准，９例为确诊病例，表现为双侧颈内动脉末端、前动脉、中动脉起始部狭窄或闭塞，其中６例在双侧颅底可见烟雾状异常血管网，３例见单侧血管网；２例为可疑病例，仪表现为单侧上述异常改变。强调应严格烟雾病的诊断。本组采用颞浅动脉一硬膜脑贴敷术治疗患者１例，效果良好，结合日本该病治疗现状讨论，间接血行再建方法仍不失为烟雾病患者的合理治疗方法。     

Digital subtraction radiography for assessment of simulated root resorption cavities. Performance of conventional and reverse contrast modes

Abstract A previous study of the sensitivity and accuracy of a standardized radiographic technique for the disclosure of root cavities in a cadaver material indicated that it was not possible to perceive small artificial “resorption” cavities. Using the same material, the aim of the present study was to evaluate whether the use of subtraction radiography would improve the detection of root cavities. In an autopsy material of five mandibular blocks each containing two premolars, small, medium, and large cavities were drilled in the cervical, middle, and apical thirds of the proximal and oral root surfaces. Each jaw block was radiographed before (B) and after (A) cavity preparation with three different exposure times resulting in light, medium, and dark film densities. The radiographs were digitized. Digital subtraction was performed between the A- and B images of varying densities by a computer program developed for dental subtraction radiography. Conventional and reverse contrast modes of the subtraction image were assessed independently by four observers. The results showed small inter- and intraobserver differences in diagnostic accuracy for assessment of total number of root cavities. Original film density did not influence the diagnostic performance in the resulting subtraction image. Contrast mode in the subtraction image influenced diagnostic performance as the majority of observers did best with the reverse contrast mode (p<0.05). Some of the small root cavities were disclosed by the subtraction technique, but overall accuracy was not increased compared to conventional radiography.     

Multiresolution,model-based segmentation of MR angiograms

During the last decade, the quality of MR angiograms has risen substantially and their clinical utility has been demonstrated progressively. This acceptance has created a need for tools with which to summarize and display the information available. We have used a model-based segmentation technique to extract vascular morphology and local flow parameters from phase contrast MR angiograms. A multiresolution data structure is used as the basis of recursive decision-making to identify regions of blood flow. The resulting data representation allows more efficient data handling in subsequent processing and visualization and is directly applicable to the creation of a connected graph model of vascular regions. We describe this flow feature extraction algorithm and demonstrate the utility of the results.     

三维时间飞跃法MR血管造影血液铸型诊断颈内动脉系颅内动脉瘤的优势

目的　与多层面螺旋CT三维血管造影 (MS 3D CTA)和DSA比较 ,探讨三维时间飞跃法MR血管造影 (threedimensionaltimeofflightMRA ,3DTOFMRA)图像后处理血液铸型技术 (fly around)诊断颈内动脉系颅内动脉瘤的优势和临床应用价值。方法　 18名疑诊颈内动脉系颅内动脉瘤病人 ,男 4例 ,女 14例 ;年龄 17～ 76岁 ,平均 4 9 8岁 ;其中蛛网膜下腔出血 (SAH) 14例、动眼神经麻痹 4例。所有病人均接受 3DTOFMRA和MS 3D CTA检查 ,17名接受DSA检查 ,确诊后均经手术治疗。 3DTOFMRA用Toshiba 1 5T超导型MR系统VISART的 3D TOF序列采集原始数据。其参数为 :TR 30ms,TE 6 8ms ,反转角 2 0° ,视野 (FOV) 17cm× 19cm ,矩阵 16 0× 2 5 6 ,采集层块厚度 5 0～ 6 0mm ,层厚 1 2mm ;原始图像后处理方法采用最大密度投影 (MIP)和血液铸型。MS 3D CTA用Toshiba多层螺旋CT Aquilion采集原始数据。其参数为 :扫描速度 0 5s/r,层厚 1 0mm ,螺距 3 5 ;用高压注射器静脉注射非离子型对比剂 ,注射剂量 2 0ml/kg体重 ,注射流率 4 0～ 5 0ml/s ,延迟时间 15～ 18s ;原始图像后处理方法同 3DTOFMRA。图像后处理工作站均用SGIO2 ,后处理软件为Alatoview ,版本 1 4 2。DSA用SiemensMulti StartOT经股动脉插管行常规脑动脉四血管造影     

血脂代谢紊乱与冠状动脉病变严重程度的关系

目的:分析血脂代谢异常与冠状动脉狭窄程度的关系.方法:对366例因胸痛而就诊的患者行选择性冠状动脉造影,按冠状动脉狭窄程度分为正常对照组、单支病变组、双支病变组、多支病变组.同时观察患者血脂各成分,并对各组指标进行统计学分析.结果:总胆固醇(TC)、甘油三脂(TG)、低密度脂蛋白胆固醇(LDL-C)、高密度脂蛋白胆固醇(HDL-C),在各组之间存在差异,尤其多支病变组与正常组之间差异显著(P＜0.01).TC、TG、LDL-C随冠状动脉病变加重而增加,HDL-C随冠状动脉病变加重而减少,LDL-C与冠状动脉狭窄程度呈正相关,HDL-C与冠状动脉狭窄程度呈负相关.结论:血脂代谢紊乱与冠状动脉狭窄的发生发展有内在的联系,对于预测有无冠状动脉病变及其进展有一定临床意义.     

View ordering for magnetization prepared steady state free precession acquisition: application in contrast-enhanced MR angiography.

Magnetization prepared segmented acquisition requires a view order that maximizes signal contrast during the acquisition of the central portion of k-space. Steady state free precession (SSFP) acquisition further requires a view order that minimizes changes in phase-encoding gradients from one repetition to the next in order to minimize eddy current artifacts. In this article, optimal view ordering schemes satisfying these two requirements are formulated and applied to inversion prepared 3D SSFP contrast-enhanced MR angiography (MRA). Experiments on phantoms and pigs demonstrated improved background suppression and reduced image artifacts.