Virtual endoscopic images by 3D FASE cisternography for neurovascular compression.

Three-dimensional fast asymmetric spin echo (3D FASE) cisternography provides high spatial resolution and excellent contrast as a water image acquisition technique. It is also useful for the evaluation of various anatomical regions. This study investigated the usefulness and limitations of virtual endoscopic images obtained by 3D FASE MR cisternography in the preoperative evaluation of patients with neurovascular compression. The study included 12 patients with neurovascular compression: 10 with hemifacial spasm and two with trigeminal neuralgia. The diagnosis was surgically confirmed in all patients. The virtual endoscopic images obtained were judged to be of acceptable quality for interpretation in all cases. The areas of compression identified in preoperative diagnosis with virtual endoscopic images showed good agreement with those observed from surgery, except in one case in which the common trunk of the anterior inferior cerebellar artery and posterior inferior cerebellar artery (AICA-PICA) bifurcated near the root exit zone of the facial nerve. The veins are displayed in some cases but not in others. The main advantage of generating virtual endoscopic images is that such images can be used for surgical simulation, allowing the neurosurgeon to perform surgical procedures with greater confidence.     

Preoperative identification of subthalamic nucleus for deep brain stimulation using three-dimensional phase sensitive inversion recovery technique.

PURPOSE: We assessed the feasibility of utilizing three-dimensional (3D) phase sensitive inversion recovery (IR) images for preoperatively determining deep brain stimulator position. METHODS: We measured geometric distortion with a grid phantom and evaluated images of 3 volunteers to determine optimum imaging parameters for 3D phase sensitive IR. RESULTS: Geometric distortion measured less than 1.0%. Respective inversion and recovery times, which provided high T(1) contrast between the subthalamic nucleus and adjacent tissue, were 200 and 4000 ms. In studies of 3 volunteers and 2 patients, the subthalamic nucleus was clearly depicted in 3D phase sensitive IR images. The measured coordinates of the subthalamic nucleus agreed well with those calculated by conventional estimation from midpoint of the anterior and posterior commissure. CONCLUSION: Three-dimensional phase sensitive inversion recovery was useful in visualizing the subthalamic nucleus for effective deep brain stimulation.     

MR imaging of renal cell carcinoma: associations among signal intensity, tumor enhancement, and pathologic findings

The purpose of this study was to compare the MR characteristics of renal cell carcinomas against histologic findings and to assess the correlations among signal intensity, tumor enhancement, and pathologic findings. Fifty-four patients (56 lesions) were examined by MR imaging and then underwent partial or radical nephrectomy. The pathologic diagnosis of all lesions was renal cell carcinoma. All MR examinations were performed as dynamic studies using the same 1.5-T scanner. MR characteristics were compared against pathologic findings after resection, and the correlations among signal intensity, tumor enhancement, and pathologic findings were then assessed. A significant correlation was observed between tumor grade and tumor enhancement, with G3 lesions tending to show little enhancement. Regardless of the histologic classification, G3 tumors were found to contain highly heterotypic cancer cells and very few vessels by histopathologic examination. No significant correlations were noted between the other MR characteristics and pathologic findings. Renal cell carcinomas showing little enhancement tend to be highly malignant lesions based on the pathologic findings. Special consideration is required for these tumors with regard to the selection of surgical intervention and follow-up observation.     

Differential diagnosis of adrenal masses by chemical shift and dynamic gadolinium enhanced MR imaging

Chemical shift MRI is widely used for identifying adenomas, but it is not a perfect method. We determined whether combined dynamic MRI methods can lead to improved diagnostic accuracy. Fifty-seven adrenal masses were examined by chemical shift and dynamic MR imaging using 2 MR systems. The masses included 38 adenomas and 19 non-adenomas. In chemical shift MRI studies, the signal intensity index (SI) was calculated, and the lesions classified into 5 types in the dynamic MRI studies. Of the 38 adenomas studied, 37 had an SI greater than 0. In the dynamic MRI, 34 of 38 adenomas showed a benign pattern (type 1). If the SI for the adenomas in the chemical shift MRI was considered to be greater than 0, the positive predictive value was 0.9, and the negative predictive value was 0.94 and kappa = 0.79. If type 1 was considered to indicate adenomas in the dynamic MRI, the corresponding values were 0.94, 0.81 and kappa = 0.77 respectively. The results obtained when the 2 methods were combined were 1, 0.95 and kappa = 0.96 respectively. The chemical shift MRI was found to be useful for identifying adenomas in most cases. If the adrenal mass had a low SI (0 < SI < 5), dynamic MRI was also found to be helpful for making a differential diagnosis.     

Differences in heart rate variability between young and elderly normal men during graded head up tilt

An autoregressive spectral analysis of heart rate variability (HRV) was used to analyze the differences in autonomic functions during graded head up tilt (HUT) between young and elderly men. After recording at the 0 degree position, the table was rotated to an upright position. The incline of the table was increased progressively to 15 degrees, 30 degrees and 60 degrees. The data obtained from seven young subjects (mean age of 20.0 years) and nine elderly subjects (mean age of 63.3 years) were analyzed. The high frequency components expressed by normalized units (HFnu) were used as the parasympathetic indicators, and HFnu decreased with tilt angle in both age groups. These results suggested that parasympathetic withdrawal have an important role in adaptation to an upright posture in both age groups. However, mean HF amplitude at the 0 degree position in elderly men was not significantly different from that of young men at 60 degrees tilt. A significant interaction effect (age group x tilt angle) was found for mean HF amplitude. The increase of the low frequency components expressed by normalized units (LFnu) and the LF-to-HF ratio in elderly subjects from 0 degree to 15 degrees seemed to be larger than that in young subjects. Sympathetic activities may be sensitive to lower levels of orthostatic stress in the elderly, and the elderly workers are easily affected by a change in workload. Therefore, keeping the workload lower and constant may be recommended to avoid excessive sympathetic activation among the elderly.     

Voiding Dysfunction in Multiple Sclerosis: Disease Review and Management

Multiple sclerosis (MS) is the most common neurologic disease diagnosed among young adults in whom neurons within the central nervous system are affected causing inflammation, loss of the myelin sheath, and neural degeneration. As such, many systems are potentially involved including the urinary tract. However, treatment of voiding symptoms must be individualized to each patient, taking into account the many facets of the disease, i.e., the direct effects of MS on the bladder, the ability of the patient to address those effects, the potential side effects of treatments, the complications of the disease or treatments on the ability to treat the underlying disease, and the changing nature of MS itself if the patient progresses. The purpose of this article is to review the voiding dysfunction associated with MS and its treatments relevant to the practicing urologist.     

Involvement of intestinal permeability in the oral absorption of clarithromycin and telithromycin

The involvement of intestinal permeability in the oral absorption of clarithromycin (CAM), a macrolide antibiotic, and telithromycin (TEL), a ketolide antibiotic, in the presence of efflux transporters was examined. In order independently to examine the intestinal and hepatic availability, CAM and TEL (10 mg/kg) were administered orally, intraportally and intravenously to rats. The intestinal and hepatic availability was calculated from the area under the plasma concentration–time curve (AUC) after administration of CAM and TEL via different routes. The intestinal availabilities of CAM and TEL were lower than their hepatic availabilities. The intestinal availability after oral administration of CAM and TEL increased by 1.3‐ and 1.6‐fold, respectively, after concomitant oral administration of verapamil as a P‐glycoprotein (P‐gp) inhibitor. Further, an in vitro transport experiment was performed using Caco‐2 cell monolayers as a model of intestinal epithelial cells. The apical‐to‐basolateral transport of CAM and TEL through the Caco‐2 cell monolayers was lower than their basolateral‐to‐apical transport. Verapamil and bromosulfophthalein as a multidrug resistance‐associated proteins (MRPs) inhibitor significantly increased the apical‐to‐basolateral transport of CAM and TEL. Thus, the results suggest that oral absorption of CAM and TEL is dependent on intestinal permeability that may be limited by P‐gp and MRPs on the intestinal epithelial cells. Copyright © 2014 John Wiley & Sons, Ltd.     

Testicular extrusion due to scrotoschisis

We present the eighth case of testicular extrusion through a congenital defect in the scrotal wall, along with a review of the published reports and a discussion of its possible embryogenesis.