Assessment of clinical renal preservation by phosphorus-31 magnetic resonance spectroscopy

To evaluate the role of magnetic resonance spectroscopy (MRS) and to develop surface coils for assessing cadaveric renal viability during hypothermic storage, we used the monophosphate/inorganic phosphate ratio (MP/Pi) to monitor phosphorous metabolites in intact kidneys during various renal preservation maneuvers. Eighteen canine kidneys and 16 cadaveric kidneys were studied as follows: Group 1 (N = 4) in situ kidneys were monitored by implanted MRS coils; Group 1 (N = 4) ex vivo kidneys were immediately attached to vascular cannulas and monitored by MRS surface coils during normothermic perfusion; Group 3 (N = 4) kidneys were removed, cold-flushed and, after 24 hours of 4C storage, monitored by MRS surface coils before and during four hours of reperfusion via vascular cannulas; Group 4 (N = 6) kidneys were removed, cold-flushed and monitored by surface coils during cold storage up to 72 hours. In addition, 16 cadaveric kidneys were studied while in sterile cold-storage containers. Postoperative renal function was followed in recipient patients. The MP/Pi ratios in Group 1 kidneys correlated with the ability to regenerate adenosine triphosphate (ATP). Groups 2 and 3 showed similar regeneration of ATP and MP/Pi after postischemic reperfusion, and the signal-to-noise ratios of the surface coils were better than those in the implanted coils in Group 1. Surface-coil monitoring in Group 4 kidneys showed predictable decay rates of MP/Pi during one to 72 hours of cold storage; in contrast, simultaneous cortical medullary microcirculation studies with 99mTc-macroaggregated albumin were inconclusive. Human cadaveric kidneys with high MP levels were associated with excellent renal function after transplantation, while those with low MP (less than or equal to 0.50) were associated with nonviability. We conclude that MRS is a practical and safe diagnostic modality for clinical transplantation.     

Magnetic resonance imaging of renal calculi: an in vitro study

Extracorporeal shock wave lithotripsy (ESWL) has been established as a standard method of urinary stone treatment. Poor fragmentation with an increased rate of complications has been noticed with certain calculi types (calcium oxalate monohydrate and cystine). In devising appropriate pre-operative strategies, it would be useful to know the calculi composition. We have investigated the in vitro utility of using magnetic resonance imaging (MRI) in analyzing urinary calculi. Our in vitro analysis found no difference in signal characteristics between calculi of varying composition. The absence of signal can be understood from a molecular basis. We conclude that MRI will not offer any assistance in characterizing the composition of urinary calculi.     

Advances in oncologic imaging

Imaging has become a pivotal component throughout a patient's encounter with cancer, from initial disease detection and characterization through treatment response assessment and posttreatment follow‐up. Recent progress in imaging technology has presented new opportunities for improving clinical care. This article provides updates on the latest approaches to imaging of 5 common cancers: breast, lung, prostate, and colorectal cancers, and lymphoma. CA Cancer J Clin 2012. © 2012 American Cancer Society.     

Adherence to medication for chronic disorders during pregnancy: results from a multinational study

Background For a variety of chronic disorders, low medication adherence during pregnancy may jeopardize maternal as well as foetal health. Little is known about how closely pregnant women follow their chronic pharmacotherapy regimens. Objective To explore the level of adherence to medication for a variety of chronic disorders, namely cardiovascular, rheumatic and bowel disorders, diabetes and epilepsy, during pregnancy and to identify determinants of low adherence during pregnancy. Setting This multinational, cross-sectional, internet-based study was undertaken in 18 countries in Europe, North America and Australia. Data originating from some South American countries were also collected. Methods The study period lasted from 1-October-2011 to 29-February-2012. By using an anonymous on-line questionnaire we collected information about maternal demographics, chronic disorders and related medication use during pregnancy, and women’s pregnancy-specific beliefs about medication. Main outcome measure Adherence to medication during pregnancy via the 8-item Morisky Medication Adherence Scale (MMAS-8). Results A total of 210 pregnant women reported chronic medication use during pregnancy and filled in the MMAS-8. Overall, 36.2 % had low medication adherence. On the basis of the MMAS-8, the rates of low adherence were 55.6 % for medication for rheumatic disorders, 40.0 % for epilepsy, 36.1 % for bowel disorders, 32.9 % for cardiovascular disorders, and 17.1 % for diabetes. A lack of folic acid use, having previous children, and individual pregnancy-specific beliefs about medication were significant determinants of low medication adherence during pregnancy. Conclusion Many pregnant women had low adherence to their chronic pharmacotherapy regimens during pregnancy. Women’s beliefs about medication were a central factor determining low adherence.