Thalamo-cortical networks in subtypes of migraine with aura patients

BackgroundWe searched for differences in resting-state functional connectivity (FC) between brain networks and its relationship with the microstructure of the thalamus between migraine with pure visual auras (MA), and migraine with complex neurological auras (MA+), i.e. with the addition of at least one of sensory or language symptom.Methods3T MRI data were obtained from 20 patients with MA and 15 with MA + and compared with those from 19 healthy controls (HCs). We collected resting state data among independent component networks. Diffusivity metrics of bilateral thalami were calculated and correlated with resting state ICs-Z-scores.ResultsAs compared to HCs, both patients with MA and MA + disclosed disrupted FC between the default mode network (DMN) and the right dorsal attention system (DAS). The MA + subgroup had lower microstructural metrics than both HCs and the MA subgroup, which correlated negatively with the strength of DMN connectivity. Although the microstructural metrics of MA patients did not differ from those of HCs, these patients lacked the correlation with the strength of DAS connectivity found in HCs.ConclusionsThe present findings suggest that, as far as MRI profiles are concerned, the two clinical phenotypes of migraine with aura have both common and distinct morpho-functional features of nodes in the thalamo-cortical network.     

Accuracy of preoperative endo-rectal coil magnetic resonance imaging in detecting clinical under-staging of localized prostate cancer

Objectives

To assess the accuracy of intra-rectal coil magnetic resonance imaging (ER-MRI) for staging early prostate cancer (EPC).

Materials and methods

ER-MRI was performed with the Magnetom Symphony 1.5 Tesla system. ER-MRI and pathology findings were statistically correlated.

Results

One hundred and fifty-four consecutive patients underwent radical prostatectomy (RRP) for EPC (cT1c-2 Nx M0). An average age was 66, mean PSA 11.04 µg/L (median 7.33 µg/L) and mean pathologic Gleason score 6. Pathology detected 97 out of 154 patients (63 %) as EPC and 57 cases (37 %) as extra-prostate extension (EPED) (pT3) with extra-capsular extension (ECE) (pT3a) in 41 (27 %) and seminal vesicle invasion (SVI) (pT3b) in 16 (10 %). ER-MRI staged 100 patients (65 %) as cT2 and 54 (35 %) as EPED with ECE in 37 cases (24 %) and SVI in 17 (11 %). ER-MRI sensitivity, specificity, positive predictive value, negative predictive value, overall accuracy resulted respectively 0.78, 0.96, 0.86, 0.92, 0.91 for ECE as well as 0.88, 0.98, 0.82, 0.99 and 0.97 for SVI.

Conclusion

ER-MRI was effective in detecting preoperative EPC under-staging. In the next future, multi-parametric 3-Tesla ER-MRI will be the procedure for diagnosing, staging and following-up prostate cancer patients.     

Procedural applications of ultrasound

Many invasive procedures are now safer and more efficient with the use of ultrasound guidance. As emergency physicians continue to develop skills in sonography, new applications of this technology will continue to impact the practice of emergency medicine.     

Delta Opiates Increase Ischemic Tolerance in Isolated Rabbit Jejunum

Mammalian hibernation is mediated by humoral agonists of the delta opioid receptor (DOR). Moreover, transfer of either humoral or synthetic DOR agonists to non-hibernators reportedly induces a state of improved myocardial ischemic tolerance. OBJECTIVE: To determine whether the DOR agonist D-Ala 2, D-Leu 5, enkephalin (DADLE) similarly elicits protection in noncardiac-i.e., mesenteric-tissue. METHODS: In Protocols 1 and 2, the authors developed and characterized an in vitro model of mesenteric ischemia/reperfusion in isolated rabbit jejunum by documenting the effect of increasing ischemic duration (0 to 120 minutes) and the relative importance of glucose and/or oxygen deprivation on the evolution of jejunal injury. In Protocol 3, jejunal segments were randomized to receive either no treatment (controls) or 15 minutes of pretreatment with 1 microM DADLE, followed by 60 minutes of simulated ischemia and 30 minutes of reperfusion. Jejunal injury was quantified by repeated, time-matched assessment of peak contractile force evoked by 1 microM acetylcholine (all protocols) and delineation of tissue necrosis (Protocol 1). RESULTS: Development of significant jejunal injury required combined oxygen/glucose deprivation. Moreover, there was a direct relationship between ischemic duration and tissue injury, and a significant inverse correlation between reperfusion contractile force (% of baseline) and the extent of smooth muscle necrosis (r(2) = 0.87; p < 0.01). Most notably, mesenteric ischemia/reperfusion injury was attenuated by DADLE: reperfusion contractile force was 47 +/- 5% versus 36 +/- 5% in DADLE-treated versus control segments (p < 0.01). CONCLUSIONS: Treatment with the delta opioid agonist DADLE increases ischemic tolerance of isolated rabbit jejunum.     

Endogenous testosterone density is an independent predictor of pelvic lymph node invasion in high-risk prostate cancer: results in 201 consecutive patients treated with radical prostatectomy and extended pelvic lymph node dissection

International Urology and Nephrology - To evaluate the influence of endogenous testosterone density (ETD) on pelvic lymph node invasion (PLNI) in high risk (HR) prostate cancer (PCa) treated with...     

Primary lymphoepithelioma-like carcinoma of the urinary bladder: Report of one case with review and update of the literature after a pooled analysis of 43 patients

Background and objectives:Lymphoepithelioma-like carcinoma (LELC) is anundifferentiated epithelial tumor with a denseinflammatory infiltrate that resembles thelymphoepithelioma of the nasopharinx occurringin other sites. Primary LELC of the bladder(LELCB) was first reported by Zukerberg et alin 1991. The incidence of LELCB is 0.4%–1.3% of all bladder carcinomas. The mean ageat diagnosis is 69 years. Of the patientpopulation 69% are men. Herein we report onone more case of primary predominant LELCB andreview all the English literature concerningthis subject after performing a pooled analysisof the cases recorded in the Eglish literatureincluding the present one.Materials and methods: The reports of 43patients including the present case of primaryLELCB from the English literature werecollected from 1991 to 2002. Patients wereevaluated for age, sex, primary and adjuvanttreatments, clinical staging, follow-up andoutcome, and disease related survival. Theoverall patient population was separated into 3groups according to the LELCB classification ofAmin. Results: The overall patientpopulation included 31 males and 12 females.Average age was 68.4 years (range 52–84). LELCBhistological subtypes resulted pure in 17cases(40%), predominant in 16 (37%) and focal in10 (23%). Mean follow-up was 37.7 months(range 0–216). Outcome resulted as follows: 26patients (62%) did not show evidence ofdiasease (62%), 11 (26%) died of disease, 1(2%) was alive with metastases, and 4 (10%)died for causes unrelated to the primarydisease. Survival rate related to specificdisease resulted 71%. Mean follow-up was 48.1in the first group (pure LELCB), 32 in thesecond (predominant LELCB), and 30.3 in thethird one (focal LELCB). Patients with notevidence of disease were 13 (81%) in group 1,13 (82%) in group 2, and 0 in group 3.Patients who died of their disease resulted 1(6%) in the first group, 1 (6%) in thesecond, and 9 (90%) in the third one. Patientswho died for disease not related to the primarytumor were 2 (13%) in the first group, 1 (6%)in the second, and 1 (10%) in the third one.One patient (6%) was alive with metastases ingroup 2. Survival rate related to specificdisease resulted 93% in the first group, 93%in the second one, and 0% in the third one.Conclusions:To date, there are no clear guide lines for the treatment of LELCB. Treatments performedinclude both deep transurethral resection ofthe tumor (TUR-B) as well as partial or radicalcystectomy, with or without adjuvant treatmentsincluding systemic chemotherapy andradiotherapy. The prognosis is favorable forpatients presenting with the pure andpredominant forms with a diploid DNA patternand very poor for patients presenting withfocal LELCB. Bladder salvage therapy byperforming both TUR-B alone or combined withadjuvant systemic chemotherapy may be areasonable option for patients with pure orpredominant LELCB, while radical surgery withadjuvant systemic therapy may be indicated forfocal muscle invasive LELCB.     

Adult primary teratoma of the testis – report on 5 cases in clinical stage I disease

Objectives:Testis pure teratoma accounts for 2.7% to 3% of all germcell tumors in adult where it behaves as a malignant neoplasm. Pureteratoma of the testis presents in clinicalstage I disease in 44% of thepatients whose risk of having pathologicalstage II disease is 16.7% to19.2%. Herein we report on 5 casesof adult pure teratoma of the testispresenting itself in clinical stage I disease.Materials and methods: From September 1976 to February 2000, 75patients underwent orchidectomy for clinical stage I nonseminomatous germcell cancer of the testis. Testis pure teratoma was detected in 5 patients(7%). Testis tumor markers wereevaluated in all cases. Patients underwentimaging examination to detect the clinical stage of the disease. Treatmentoptions after orchidectomy included retroperitoneal lymph node dissection(RPLND) in 4 patients and surveillance in 1.Results: The average age of the patients was 31 years (range 24–45).The tumor was on the left sided in 3 cases(60%) and right in 2 (40%).Tumor average size was 3.2 cm (rang 1–6).Histopathology detected thefollowing subtypes: mature teratoma in3 cases (60%), immature teratomain 1 (20%) and teratoma with malignanttransformation in (20%). Allpatients were at clinical stage I disease. Germ cell cancer microscopicmetastatic disease including embryonal carcinoma was detected in 1dissected lymph node of 1/4 patients (25%).Average follow up was 166months (range 93–249). All patients werealive and disease free and norelapses were detected during the follow up period.Conclusions: Primary pure teratoma of the testis does not respond tochemotherapy nor does it to radiation therapy. The disease treatmentoptions after orchidectomy for patients withclinical stage I disease includeRPLND or surveillance with their relativerisks and benefits. RPLND is thechosen treatment because it is both staging and treating. A close a longterm follow up is required since pure teratoma metastatic disease mayclinically develop after more than 10 years.     

Adrenal extramedullary hematopoiesis: Report on a pediatric case and update of the literature

The authors report on a rare pediatric case of adrenal extramedullary hematopoiesis in a patient with beta-thalassemia disease. The lesion was clinically discovered as incidentaloma of the right adrenal gland and treated by surgery. Adrenal extramedullary hematopoiesis may clinically be detected as incidentaloma. Adrenal incidentalomas presenting with hematologic disorders, such as agnogenic myeloid aplasia and beta-thalassemia, need careful imaging as well as adrenal hormonal investigation in order to exclude malignancy and sublinical hypersecretory syndromes. Ultrasound or CT-FNA of the lesion are effective in finding out the disease.     

Prostate cancer and coexisting incidental Paget's disease – Report on a case

Prostate cancer coexisting with asymptomatic Paget's disease (osteitisdeformans) may be difficult to stage. The skeletal lesions of both prostatecancer and Paget's disease may closely resemble each other, as appearingon imaging. A case of clinically localized prostate cancer coexisting withincidental Paget's disease is herein reported. Prostate cancer andcoexisting incidental Paget's disease both need careful evaluation and closefollow-up of the skeleton by imaging, because there is a risk of the formerinvolving the skeleton at low clinical stages and low PSA serum levels, aswell as the latter developing osteosarcoma.     

Leiomyosarcoma of the bladder fourteen years after cyclophosphamide therapy for retinoblastoma

We report a case of bladder leiomyosarcoma which occurred in a 22-year-old female who had been treated with cyclophosphamide for a period of 68 months for retinoblastoma diagnosed at 18 months postpartum. Partial cystectomy was performed. Forty-two months after the operation she is tumor-free.