2016-03-31T06-28-48Z
Source: Düşünen Adam: The Journal of Psychiatry and Neurological Sciences
Esra Akyuz Ozkan, Ali Irfan Gul, Zeynep Tuba Ozdemir, Hasim Husrevsahi, Zehra Yildirim, Esra Domur, Ummugulsum Aliye Gecit.
Objective: The present study aimed to assess depression and social anxiety symptoms in obese children. Methods: The Childrens Depression Inventory (CDI) and the Social Anxiety Scale for Children - Revised (SASC-R) were administered to 80 obese children and 82 controls. Results: The obese group consisted of 42 male and 38 female children, mean age 12.48±2.70 years (range 7-17 years), mean body mass index (BMI) was 27.47±3.72 kg/m2; controls were 43 male, 39 female children, mean age 12.93±2.32 years (range 9-17 years), mean BMI was 16.92±5.17 kg/m2. Mean social anxiety scores were higher in the obese group than in the control group. Mean depression scores were significantly higher in the obese group than in the control group. The mean depression scores were higher in obese females compared to control females as well as in males. The mean social anxiety scores were higher in obese females than in controls as well as in males. There was no correlation between BMI and depression and social anxiety scores in obese males and females. Among obese childeren 21.5% and among the control group 14.3% had a value of CDI above the cut-off point, and this was statistically significant. Among obese childeren 15.2% of females and 10.4% of males had a value above the cut-off point, but the difference between sexes was not statistically significant. Discussion: Depression and social anxiety symptoms were more common in obese children and did not relate to the degree of obesity. The prevention of childhood obesity is important in both sexes for reducing the risk of psychological disorder in adulthood.
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Medicine by Alexandros G.Sfakianakis,Anapafseos 5 Agios Nikolaos,Crete 72100,Greece,tel :00302841026182 & 00306932607174
Πέμπτη 31 Μαρτίου 2016
Evaluation of depression and social anxiety symptoms in obese children
Relation of the Nine Types of Temperament Model with personality disorders
2016-03-31T06-28-48Z
Source: Düşünen Adam: The Journal of Psychiatry and Neurological Sciences
Enver Demirel Yilmaz, Ali Gorkem Gencer, Ozge Unal, Mehmet Palanci, Mehmet Kandemir, Ziya Selcuk, Omer Aydemir.
Objective: Aim of this study is to determine the correspondence between personality categories and the types making up the Nine Types of Temperament Model (NTTM) a new temperament model which evaluates personality disorders within the context of temperament traits and maladaptive personality features- and conceptualization of NTTM types. Method: The sample group is composed of 117 participants with a personality disorder. SCID II and Nine Types of Temperament Scale (NTTS) were applied to participants. Results: According to the findings, all NTTM types have shown significant correlation with at least one personality disorder. According to the regression analysis results, it was determined that the NTTM types were explained by personality disorders at a rate of 19-41%. Conclusions: In this study, it is found that knowing the temperament features that form the basis of an individuals personality structure is helpful to diagnose and to determine the tendency to develop personality disorders that are pathological responses to personality characteristics. In addition, this study brings up questions such as whether the individual differences between patients with the same personality disorders can be evaluated on the basis of temperament and whether it is possible to determine therapy and treatment approaches according to an individuals temperament type.
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Psychometric properties of the Inventory of Interpersonal Problems Circumplex Scales short form: a reliability and validity study
2016-03-31T06-28-48Z
Source: Düşünen Adam: The Journal of Psychiatry and Neurological Sciences
Miray Akyunus, Tulin Gencoz.
Objective: Considering the lack of an instrument in Turkish to measure individuals interpersonal difficulties, our aim was to adapt a short version of the Inventory of Interpersonal Problems Circumplex Scales (IIP-C) for Turkish culture, and we studied the psychometric properties of the scale. Method: Our study included 1298 adult participants from the normal population (411 females and 887 males) between the ages of 18 and 68. In order to establish reliability and validity of the Turkish version of the IIP-C, internal consistency, test-retest reliability, split-half reliability coefficients, and concurrent and criterion validity studies were conducted. The validity study analyzed correlations with the Positive and Negative Affect Schedule, the Brief Symptom Inventory, the Multidimensional Scale of Perceived Social Support and the Basic Personality Traits Inventory. Results: The results of the study indicated good internal consistency, test-retest and split-half reliability coefficients of the IIP-C, assessing overall level of interpersonal difficulty and distress due to various interpersonal problems. Moreover, findings supported concurrent and criterion validity of the inventory, in addition to the two-factor structures consistent with the original inventory. Conclusion: The psychometric properties of IIP-C seem to be acceptable; therefore, the instrument can be utilized for research and clinical purposes in Turkey.
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Review of the diagnosis and treatment of pregnant psychiatric inpatients
2016-03-31T06-28-48Z
Source: Düşünen Adam: The Journal of Psychiatry and Neurological Sciences
Kader Semra Karatas, Julide Guler, Aytul Hariri, Feride Ezgi Buyuksahin Unal.
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Analysis of gene expression in mouse brain regions after exposure to 1.9 GHz radiofrequency fields
10.3109/09553002.2016.1159353<br/>James P. McNamee
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A case of patch stage of Kaposi’s sarcoma and discussion of the differential diagnosis
A 55-year-old HIV positive male had a skin lesion biopsy which showed atypical vascular proliferation within the superficial and deep dermis with mild atypia of lining endothelial cells. A sparse lymphoplasmacytic infiltrate surrounding the irregular vascular channels was noted. Immunohistochemistry highlighted the atypical blood vessels with the vascular markers CD31, CD34 and Factor VIII. The differential diagnosis included unusual vascular or lymphatic proliferations, stasis dermatitis, kaposiform hemangioendothelioma, progressive lymphangioma and angiosarcoma with focal Kaposi's sarcoma features. Characteristic human herpes virus-8 positive staining helped support the diagnosis of patch stage of Kaposi's sarcoma. Herein, we discuss the case findings, differential diagnosis and characteristic histological findings associated with the patch stage of Kaposi's sarcoma which can be an elusive diagnosis.
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Influence of different fixation protocols on the preservation and dimensions of cardiac tissue
Abstract
Recent extensive progress in invasive cardiac procedures has triggered a wave of dozens of heart morphometric anatomical studies that are carried out largely using autopsied samples fixed in formaldehyde solution prior to observations and measurements. In reality, very little is known about changes in heart tissue dimensions during fixation. The aim of this study was therefore to investigate how fixation affects the dimensions of cardiac tissue, and if different types and concentrations of reagents affect this phenomenon. A total of 40 pig heart samples were investigated, and seven different measuring sites were permanently marked in every heart prior to fixation. Four study groups (n = 10 each) were assembled that differed only in concentration and the type of fixative: (i) 2% formaldehyde solution; (ii) 4% formaldehyde solution (formalin); (iii) 10% formaldehyde solution; (iv) alcoholic formalin. The samples were measured before and after fixation at the following time points: 24 h, 72 h and 168 h. It was found that different fixatives significantly affected different parameters. Almost all of the heart dimensions that were measured stabilized after 24 h; later changes were statistically insignificant in the point-to-point comparison. Change in the length of the interatrial septum surface was not altered significantly in any of the fixatives after 24 h of preservation. It was found that 10% formaldehyde increased the thickness of muscular tissue only after 24 h; this thickening was reduced after 72 h and was insignificant at 168 h. Other heart parameters in this group do not present significant changes over the entire fixation time duration. In conclusion, the 10% formaldehyde phosphate-buffered solution appeared to be the best fixative among the fixatives that were studied for cardiac morphometric purposes; this solution caused the smallest changes in tissue dimensions. Measurements should be obtained at least after 1 week of preservation when most parameters exhibit the smallest changes compared with the non-preserved samples.
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Non-metric variation of the middle phalanges of the human toes (II–V): long/short types and their evolutionary significance
Abstract
The human lateral toes are characterised by extreme reduction compared with other primates, and in particular other hominoids. Some phalangeal non-metric variants have been well identified in humans, in particular: triphalangeal/biphalangeal patterns, and the presence/absence of phalangeal secondary centres of ossification. The purpose of the present study was to describe and analyse an original non-metric variation of the middle phalanges of the lateral toes. The material consisted of 2541 foot radiographs that came from 2541 different European adult individuals. Two morphological types of the middle phalanx were defined as a simple binary trait: long type (L) and short type (S). In feet with a triphalangeal pattern in all lateral toes (1413 cases), a mediolateral increasing gradient was observed in the occurrence of type S: 8.1% in II; 30.7% in III; 68.4% in IV; and 99.1% in V. In feet with a biphalangeal pattern in one or more lateral toes (III–V; 1128 cases), type S occurred more frequently than in triphalangeal feet. Of the 30 theoretical arrangements of the L/S types in the lateral toes (II–V) in a complete foot, only 13 patterns were observed. Seven patterns represented 95.6% of the population: LLSS (20.9%), LLLS (17.1%), LSS (15.9%), SSS (14.5%), LSSS (12.7%), LLS (10.1%) and SSSS (4.4%). Type L can be interpreted as the primitive pattern (plesiomorphy), and type S as a derived pattern (apomorphy) that seems specific to the human species (i.e. autapomorphy). Within the specific evolution of the human foot in relation to the acquisition of constant erect posture and bipedalism, the short type of the middle phalanges can reasonably be considered as directly linked to the reduction of the lateral toes.
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Estimation of the optimum dose of vitamin D for disease prevention in older people: rationale, design and baseline characteristics of the BEST-D trial.
   | Related Articles |
Estimation of the optimum dose of vitamin D for disease prevention in older people: rationale, design and baseline characteristics of the BEST-D trial.
Maturitas. 2015 Apr;80(4):426-31
Authors: Clarke R, Newman C, Tomson J, Hin H, Kurien R, Cox J, Lay M, Sayer J, Hill M, Emberson J, Armitage J
Abstract
BACKGROUND: Previous large trials of vitamin D for prevention of fractures and other disease outcomes have reported conflicting results, possibly because the doses tested were insufficient to maintain optimum blood levels of vitamin D (25[OH]D) predicted by the observational studies. This report describes the design and baseline characteristics of the BEST-D (Biochemical Efficacy and Safety Trial of vitamin D) trial which aims to establish the best dose of vitamin D to assess in a future large outcome trial.
METHODS: The BEST-D trial will compare the biochemical and other effects of daily dietary supplementation with 100 μg or 50 μg vitamin D3 or placebo, when administered for 12 months, in 305 ambulant community-dwelling older people living in Oxfordshire, England. The primary analyses will compare 12-month mean plasma concentrations of 25(OH)D as well as the proportion of participants with a 12-month concentration >90 nmol/L between participants allocated 100 μg and participants allocated 50 μg daily. Secondary analyses will compare the two active doses (both separately and when combined) with placebo. Additional end-points include biochemical assessments of safety, blood pressure, arterial stiffness, falls, fractures, heel and wrist bone density, grip strength and physical performance and echocardiographic assessments of cardiac function in a random sample of participants.
RESULTS: About one-third of eligible participants agreed to participate in the trial. The mean age was 72 (SD 6) years with equal numbers of men and women. About one third reported a prior history of fracture or hypertension, one-fifth reported a prior cardiovascular event, and one tenth reported diabetes or a fall in the previous 6 months.
CONCLUSIONS: The results of this trial will help determine the optimum dose of vitamin D to test in a larger trial investigating whether vitamin D supplementation can reduce the risk of fractures, cardiovascular disease or cancer.
PMID: 25721698 [PubMed - indexed for MEDLINE]
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“Chain of Beads” Appearance of the Superior Mesenteric Artery
Publication date: Available online 30 March 2016
Source:European Journal of Vascular and Endovascular Surgery
Author(s): H.Y. Zhang, C.L. Chen
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Randomized Phase III study of gemcitabine plus S-1 versus gemcitabine plus cisplatin in advanced biliary tract cancer: Japan Clinical Oncology Group Study (JCOG1113, FUGA-BT).
Randomized Phase III study of gemcitabine plus S-1 versus gemcitabine plus cisplatin in advanced biliary tract cancer: Japan Clinical Oncology Group Study (JCOG1113, FUGA-BT).
Jpn J Clin Oncol. 2016 Apr;46(4):385-8
Authors: Mizusawa J, Morizane C, Okusaka T, Katayama H, Ishii H, Fukuda H, Furuse J, Hepatobiliary and Pancreatic Oncology Group of the Japan Clinical Oncology Group
Abstract
A Phase II selection design trial was conducted to identify the most promising regimen for comparison with standard therapy in chemo-naive patients with unresectable or recurrent biliary tract cancer (JCOG0805). Gemcitabine plus S-1 therapy showed better efficacy than S-1 monotherapy with acceptable safety in JCOG0805 study. Based on this result, a randomized Phase III trial was started in May 2013 to confirm the non-inferiority of gemcitabine plus S-1 therapy relative to gemcitabine plus cisplatin therapy, which is the current standard treatment for chemo-naive patients with unresectable or recurrent biliary tract cancer. A total of 350 patients will be accrued from 32 Japanese institutions within 4 years. The primary endpoint is overall survival, while the secondary endpoints are progression-free survival, adverse events, serious adverse events, clinically significant adverse events, response rate and %planned dose. This trial has been registered with the UMIN Clinical Trials Registry (http://ift.tt/1lXJedE) and the registration number is UMIN000010667.
PMID: 27025903 [PubMed - in process]
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tDCS and Robotics on Upper Limb Stroke Rehabilitation: Effect Modification by Stroke Duration and Type of Stroke
Objective. The aim of this exploratory pilot study is to test the effects of bilateral tDCS combined with upper extremity robot-assisted therapy (RAT) on stroke survivors. Methods. We enrolled 23 subjects who were allocated to 2 groups: RAT + real tDCS and RAT + sham-tDCS. Each patient underwent 10 sessions (5 sessions/week) over two weeks. Outcome measures were collected before and after treatment: (i) Fugl-Meyer Assessment-Upper Extremity (FMA-UE), (ii) Box and Block Test (BBT), and (iii) Motor Activity Log (MAL). Results. Both groups reported a significant improvement in FMA-UE score after treatment (). No significant between-groups differences were found in motor function. However, when the analysis was adjusted for stroke type and duration, a significant interaction effect () was detected, showing that stroke duration (acute versus chronic) and type (cortical versus subcortical) modify the effect of tDCS and robotics on motor function. Patients with chronic and subcortical stroke benefited more from the treatments than patients with acute and cortical stroke, who presented very small changes. Conclusion. The additional use of bilateral tDCS to RAT seems to have a significant beneficial effect depending on the duration and type of stroke. These results should be verified by additional confirmatory studies.
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Associations between heart failure and physical function in U.S. adults.
Associations between heart failure and physical function in U.S. adults.
QJM. 2016 Mar 29;
Authors: Churilla JR, Richardson MR, Pinkstaff SO, Fletcher BJ, Fletcher GF
Abstract
BACKGROUND: There is a paucity of nationally representative data in the area of heart failure (HF) and physical function (PF).
AIM: Examine the relationship(s) between HF and PF in a nationally representative sample of United States (U.S.) adults.
DESIGN: Cross-Section analysis of U.S. Adults.
METHODS: Sample (n=6,623) included adult (≥40 years of age) participants from the 1999-2006 National Health and Nutrition Examination Survey. Participants reporting HF answered questions related to their abilities to accomplish specific upper extremity and lower extremity tasks, and household chores.
RESULTS: Prevalence estimates of reporting much difficulty or the inability to stand from an armless chair was 9.9% and 4.3% (P=0.002) in those with and without HF, respectively. Similar estimates were revealed for much difficulty or inability to lift or carry 10 lbs. (16.8% and 8.6%, P=0.0004) and much difficulty or inability to do household chores (13.3% and 6.1%, P=0.0008). Following adjustments participants reporting HF had significantly greater odds of reporting much difficulty or the inability to stand from an armless chair (OR 1.93; 95% CI 1.25, 2.96), much difficulty or the inability to lift or carry 10 lbs. (OR 1.90; 95% CI 1.36, 2.65), and much difficulty or inability to do household chores (OR 2.06; 95% CI 1.41, 3.02) compared to participants not reporting HF.
CONCLUSIONS: Findings suggest U.S. adults reporting HF are more likely to report poorer PF.
PMID: 27026699 [PubMed - as supplied by publisher]
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Cognitive impairment and reduced quality of life among old-age groups in Southern Urban India: home based community residents, free and paid old-age home residents.
Cognitive impairment and reduced quality of life among old-age groups in Southern Urban India: home based community residents, free and paid old-age home residents.
QJM. 2016 Mar 29;
Authors: Samuel R, McLachlan CS, Mahadevan U, Isaac V
Abstract
AIM: The purpose of the study were a) to screen for cognitive impairment using Mini-Mental Status Examination among three old-age groups based on dwelling types in Chennai, India i.e., residential paid old-age homes, residential free (charitable) homes and home-based community-dwelling residents; b) secondly to investigate factors (demographic, psychological, medical, and disability) associated with cognitive impairment in the these old-age; c) thirdly, to investigate the independent association between cognitive impairment and health-related quality of life (QOL) among elderly across aged care dwelling types.
METHODS: A total of 499 elderly from three old-age groups were interviewed in this cross-sectional study (173 elderly home-based community-dwellers, 176 paid-home and 150 free-home residents). All the participants were interviewed for their socio-economic condition, medical morbidity, self-reported worry and anxiety, disability and QOL.
RESULTS: 42.7% free-home elderly residents were found to have cognitive impairment, while 32.4% of paid-home and 21.9% of community-dwelling elderly had cognitive impairment. The residents of free-home were less educated, had lower income and reported higher incidence of worry, anxiety, disability and poor QOL than community-dwelling or paid-home residents. Increasing age, low education, female gender, high blood pressure and disability was associated with cognitive impairment. Cognitive impairment had significant negative effect on their health-related QOL (b=-0.10, p=0.01), independent of age, gender, education, chronic illness and dwelling type.
CONCLUSION: The burden of cognitive impairment was high in all aged-care dwelling types in urban India; with free charitable home residents being worse affected. Cognitive impairment was associated with disability and poor health-related QOL in these age-care settings.
PMID: 27026698 [PubMed - as supplied by publisher]
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Two teachers and a book.
Two teachers and a book.
QJM. 2016 Mar 29;
Authors: Seaton A
PMID: 27026697 [PubMed - as supplied by publisher]
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Cerebral Toxoplasmosis.
Cerebral Toxoplasmosis.
QJM. 2016 Mar 29;
Authors: Ozaras R, Karaismailoglu B, Hasiloglu Z, Sahin S, Vatan A, Oz B
PMID: 27026696 [PubMed - as supplied by publisher]
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Hertoghe sign: an hallmark of lepromatous leprosy.
Hertoghe sign: an hallmark of lepromatous leprosy.
QJM. 2016 Mar 29;
Authors: Parrino D, Di Bella S
PMID: 27026695 [PubMed - as supplied by publisher]
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A novel mutation in KLHL3 gene causes Familial Hyperkalemic Hypertension.
A novel mutation in KLHL3 gene causes Familial Hyperkalemic Hypertension.
QJM. 2016 Mar 29;
Authors: Kelly D, Rodzlan MR, Jeunemaitre X, Wall C
PMID: 27026694 [PubMed - as supplied by publisher]
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Chondrocalcinosis and Gitelman syndrome.
Chondrocalcinosis and Gitelman syndrome.
QJM. 2016 Mar 29;
Authors: Iqbal Z, Sayer JA
PMID: 27026693 [PubMed - as supplied by publisher]
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What can imaging tell us about cognitive impairment and dementia?
What can imaging tell us about cognitive impairment and dementia?
World J Radiol. 2016 Mar 28;8(3):240-254
Authors: Narayanan L, Murray AD
Abstract
Dementia is a contemporary global health issue with far reaching consequences, not only for affected individuals and their families, but for national and global socio-economic conditions. The hallmark feature of dementia is that of irreversible cognitive decline, usually affecting memory, and impaired activities of daily living. Advances in healthcare worldwide have facilitated longer life spans, increasing the risks of developing cognitive decline and dementia in late life. Dementia remains a clinical diagnosis. The role of structural and molecular neuroimaging in patients with dementia is primarily supportive role rather than diagnostic, American and European guidelines recommending imaging to exclude treatable causes of dementia, such as tumor, hydrocephalus or intracranial haemorrhage, but also to distinguish between different dementia subtypes, the commonest of which is Alzheimer's disease. However, this depends on the availability of these imaging techniques at individual centres. Advanced magnetic resonance imaging (MRI) techniques, such as functional connectivity MRI, diffusion tensor imaging and magnetic resonance spectroscopy, and molecular imaging techniques, such as 18F fluoro-deoxy glucose positron emission tomography (PET), amyloid PET, tau PET, are currently within the realm of dementia research but are available for clinical use. Increasingly the research focus is on earlier identification of at risk preclinical individuals, for example due to family history. Intervention at the preclinical stages before irreversible brain damage occurs is currently the best hope of reducing the impact of dementia.
PMID: 27029053 [PubMed - as supplied by publisher]
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Molecular imaging of movement disorders.
Molecular imaging of movement disorders.
World J Radiol. 2016 Mar 28;8(3):226-239
Authors: Lizarraga KJ, Gorgulho A, Chen W, De Salles AA
Abstract
Positron emission tomography measures the activity of radioactively labeled compounds which distribute and accumulate in central nervous system regions in proportion to their metabolic rate or blood flow. Specific circuits such as the dopaminergic nigrostriatal projection can be studied with ligands that bind to the pre-synaptic dopamine transporter or post-synaptic dopamine receptors (D1 and D2). Single photon emission computerized tomography (SPECT) measures the activity of similar tracers labeled with heavy radioactive species such as technetium and iodine. In essential tremor, there is cerebellar hypermetabolism and abnormal GABAergic function in premotor cortices, dentate nuclei and ventral thalami, without significant abnormalities in dopaminergic transmission. In Huntington's disease, there is hypometabolism in the striatum, frontal and temporal cortices. Disease progression is accompanied by reduction in striatal D1 and D2 binding that correlates with trinucleotide repeat length, disease duration and severity. In dystonia, there is hypermetabolism in the basal ganglia, supplementary motor areas and cerebellum at rest. Thalamic and cerebellar hypermetabolism is seen during dystonic movements, which can be modulated by globus pallidus deep brain stimulation (DBS). Additionally, GABA-A receptor activity is reduced in motor, premotor and somatosensory cortices. In Tourette's syndrome, there is hypermetabolism in premotor and sensorimotor cortices, as well as hypometabolism in the striatum, thalamus and limbic regions at rest. During tics, multiple areas related to cognitive, sensory and motor functions become hypermetabolic. Also, there is abnormal serotoninergic transmission in prefrontal cortices and bilateral thalami, as well as hyperactivity in the striatal dopaminergic system which can be modulated with thalamic DBS. In Parkinson's disease (PD), there is asymmetric progressive decline in striatal dopaminergic tracer accumulation, which follows a caudal-to-rostral direction. Uptake declines prior to symptom presentation and progresses from contralateral to the most symptomatic side to bilateral, correlating with symptom severity. In progressive supranuclear palsy (PSP) and multiple system atrophy (MSA), striatal activity is symmetrically and diffusely decreased. The caudal-to-rostral pattern is lost in PSP, but could be present in MSA. In corticobasal degeneration (CBD), there is asymmetric, diffuse reduction of striatal activity, contralateral to the most symptomatic side. Additionally, there is hypometabolism in contralateral parieto-occipital and frontal cortices in PD; bilateral putamen and cerebellum in MSA; caudate, thalamus, midbrain, mesial frontal and prefrontal cortices in PSP; and contralateral cortices in CBD. Finally, cardiac sympathetic SPECT signal is decreased in PD. The capacity of molecular imaging to provide in vivo time courses of gene expression, protein synthesis, receptor and transporter binding, could facilitate the development and evaluation of novel medical, surgical and genetic therapies in movement disorders.
PMID: 27029029 [PubMed - as supplied by publisher]
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Simultaneous whole body (18)F-fluorodeoxyglucose positron emission tomography magnetic resonance imaging for evaluation of pediatric cancer: Preliminary experience and comparison with (18)F-fluorodeoxyglucose positron emission tomography computed tomography.
Simultaneous whole body (18)F-fluorodeoxyglucose positron emission tomography magnetic resonance imaging for evaluation of pediatric cancer: Preliminary experience and comparison with (18)F-fluorodeoxyglucose positron emission tomography computed tomography.
World J Radiol. 2016 Mar 28;8(3):322-330
Authors: Pugmire BS, Guimaraes AR, Lim R, Friedmann AM, Huang M, Ebb D, Weinstein H, Catalano OA, Mahmood U, Catana C, Gee MS
Abstract
AIM: To describe our preliminary experience with simultaneous whole body (18)F-fluorodeoxyglucose ((18)F-FDG) positron emission tomography and magnetic resonance imaging (PET-MRI) in the evaluation of pediatric oncology patients.
METHODS: This prospective, observational, single-center study was Health Insurance Portability and Accountability Act-compliant, and institutional review board approved. To be eligible, a patient was required to: (1) have a known or suspected cancer diagnosis; (2) be under the care of a pediatric hematologist/oncologist; and (3) be scheduled for clinically indicated (18)F-FDG positron emission tomography-computed tomography (PET-CT) examination at our institution. Patients underwent PET-CT followed by PET-MRI on the same day. PET-CT examinations were performed using standard department protocols. PET-MRI studies were acquired with an integrated 3 Tesla PET-MRI scanner using whole body T1 Dixon, T2 HASTE, EPI diffusion-weighted imaging (DWI) and STIR sequences. No additional radiotracer was given for the PET-MRI examination. Both PET-CT and PET-MRI examinations were reviewed by consensus by two study personnel. Test performance characteristics of PET-MRI, for the detection of malignant lesions, including FDG maximum standardized uptake value (SUVmax) and minimum apparent diffusion coefficient (ADCmin), were calculated on a per lesion basis using PET-CT as a reference standard.
RESULTS: A total of 10 whole body PET-MRI exams were performed in 7 pediatric oncology patients. The mean patient age was 16.1 years (range 12-19 years) including 6 males and 1 female. A total of 20 malignant and 21 benign lesions were identified on PET-CT. PET-MRI SUVmax had excellent correlation with PET-CT SUVmax for both benign and malignant lesions (R = 0.93). PET-MRI SUVmax > 2.5 had 100% accuracy for discriminating benign from malignant lesions using PET-CT reference. Whole body DWI was also evaluated: the mean ADCmin of malignant lesions (780.2 + 326.6) was significantly lower than that of benign lesions (1246.2 + 417.3; P = 0.0003; Student's t test). A range of ADCmin thresholds for malignancy were evaluated, from 0.5-1.5 × 10(-3) mm(2)/s. The 1.0 × 10(-3) ADCmin threshold performed best compared with PET-CT reference (68.3% accuracy). However, the accuracy of PET-MRI SUVmax was significantly better than ADCmin for detecting malignant lesions compared with PET-CT reference (P < 0.0001; two-tailed McNemar's test).
CONCLUSION: These results suggest a clinical role for simultaneous whole body PET-MRI in evaluating pediatric cancer patients.
PMID: 27028112 [PubMed - as supplied by publisher]
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Multidetector computed tomography features of pancreatic metastases from leiomyosarcoma: Experience at a tertiary cancer center.
Multidetector computed tomography features of pancreatic metastases from leiomyosarcoma: Experience at a tertiary cancer center.
World J Radiol. 2016 Mar 28;8(3):316-321
Authors: Suh CH, Keraliya A, Shinagare AB, Kim KW, Ramaiya NH, Tirumani SH
Abstract
AIM: To describe the multidetector computed tomography features of pancreatic metastasis from leiomyosarcoma (LMS).
METHODS: Between January 1995 and December 2012, 13 consecutive patients (11 women, 2 men; mean age of 57 years; range, 38-78 years) with pancreatic metastases from LMS were included in our study. Imaging features including location, number, largest dimension, tumor attenuation and enhancement characteristics, presence of necrosis, pancreatic ductal dilatation, common bile duct (CBD) dilatation, presence of pancreatitis, and atrophy were documented.
RESULTS: The most common site of origin of the pancreatic metastases from LMS was uterus (38.5%), followed by retroperitoneum (30.8%) and extremity (23.1%). None of the patients in our study had pancreas as the first site of metastasis. All patients developed pancreatic metastases at a median interval of 24 mo. Pancreatic metastases from LMS were solitary in 8/13 patients and multiple in 5/13 patients, had no predilection for any part of the pancreas, were hypovascular on arterial phase in 10/13 patients and associated with pancreatic duct dilatation in 3/13 patients. None had CBD dilatation. None of the pancreatic metastases in LMS cohort caused pancreatitis, and atrophy. Median duration of follow-up was 19 mo for LMS cohort during which two patients underwent resection of metastasis (median survival 45 mo) while the remaining underwent systemic therapy (median survival 13 mo).
CONCLUSION: Pancreatic metastases from LMS are often solitary and hypovascular masses and less commonly associated with pancreatic ductal dilatation, CBD dilatation, pancreatitis or pancreatic atrophy. Surgical resection of solitary LMS pancreatic metastasis can be considered due to the long survival of these patients.
PMID: 27027985 [PubMed - as supplied by publisher]
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Angiographic and volumetric effects of mammalian target of rapamycin inhibitors on angiomyolipomas in tuberous sclerosis.
Angiographic and volumetric effects of mammalian target of rapamycin inhibitors on angiomyolipomas in tuberous sclerosis.
World J Radiol. 2016 Mar 28;8(3):308-315
Authors: Sheth RA, Feldman AS, Paul E, Thiele EA, Walker TG
Abstract
AIM: To investigate the angiographic and volumetric effects of mammalian target of rapamycin (mTOR) inhibitors on angiomyolipomas (AMLs) in a case series of patients with tuberous sclerosis complex.
METHODS: All patients who underwent catheter angiography prior to and following mTOR inhibitor therapy (n = 3) were evaluated. All cross-sectional imaging studies were analyzed with three-dimensional volumetrics, and tumor volume curves for all three tissue compartments (soft tissue, vascular, and fat) were generated. Segmentation analysis tools were used to automatically create a region of interest (ROI) circumscribing the AML. On magnetic resonance images, the "fat only" map calculated from the in- and opposed-phase gradient recalled echo sequences was used to quantify fat volume within tumors. Tumor vascularity was measured by applying a thresholding tool within the ROI on post-contrast subtraction images. On computed tomography images, volume histogram analysis of Hounsfield unit was performed to quantify tumor tissue composition. The angiography procedures were also reviewed, and tumor vascularity based on pre-embolization angiography was characterized in a semi-quantitative manner.
RESULTS: Patient 1 presented at the age of 15 with a 6.8 cm right lower pole AML and a 4.0 cm right upper pole AML. Embolization was performed of both tumors, and after a few years of size control, the tumors began to grow, and the patient was initiated on mTOR inhibitor therapy. There was an immediate reduction in the size of both lesions. The patient then underwent repeat embolization and discontinuation of mTOR inhibition, after which point there was a substantial regrowth in both tumors across all tissue compartments. Patient 2 presented at the age of 18 with a right renal AML. Following a brief period of tumor reduction after embolization, she was initiated on mTOR inhibitor therapy, with successful reduction in tumor size across all tissue compartments. As with patient 1, however, there was immediate rebound growth following discontinuation of inhibitor therapy, without sustained control despite repeat embolization. patient 3 presented at the age of 5 with a left renal AML and underwent two embolization procedures without lasting effect prior to starting mTOR inhibition. As with patients 1 and 2, following discontinuation of therapy, there was immediate rebound growth of the tumor. Repeat embolization, however, was notable for a substantial reduction in intratumoral aneurysms and vascularity.
CONCLUSION: AML volume reduction as well as post-treatment rebound growth due to mTOR inhibitors involves all three tissue components of the tumor.
PMID: 27027863 [PubMed - as supplied by publisher]
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Paget’s Disease of Bone
Figure 1.
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Case 10-2016: A 22-Year-Old Man with Sickle Cell Disease, Headache, and Difficulty Speaking
Presentation of Case. Dr. Todd M. Herrington (Neurology): A 22-year-old right-handed man was admitted to this hospital because of the acute onset of headache and difficulty speaking. The patient had been well until approximately noon on the day of admission, when a dull, diffuse headache developed;…
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Carotid–Cavernous Sinus Fistula
Figure 1.
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Opioid Abuse in Chronic Pain — Misconceptions and Mitigation Strategies
Chronic pain not caused by cancer is among the most prevalent and debilitating medical conditions but also among the most controversial and complex to manage. The urgency of patients' needs, the demonstrated effectiveness of opioid analgesics for the management of acute pain, and the limited…
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Randomized Trial of Longer-Term Therapy for Symptoms Attributed to Lyme Disease
Patients with Lyme disease, which is caused by the Borrelia burgdorferi sensu lato complex (including B. afzelii and B. garinii in Europe), often report persistent symptoms. These symptoms are also referred to as the post–Lyme disease syndrome or chronic Lyme disease and may occur after…
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Extended-Release Naltrexone to Prevent Opioid Relapse in Criminal Justice Offenders
Opioid-use disorder is a chronic relapsing condition that has serious public health consequences. Opioid dependence disproportionately affects U.S. criminal justice system populations, and relapse and overdose deaths occur at high rates after release from incarceration. Evidence-based opioid…
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Time for a Different Approach to Lyme Disease and Long-Term Symptoms
The condition of most patients with Lyme disease improves after initial antibiotic therapy; however, 10 to 20% of treated patients may have lingering symptoms of fatigue, musculoskeletal pains, disrupted sleep, and lack of customary mental functions. The plausible idea that additional antimicrobial…
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Case 10-2016: A 22-Year-Old Man with Sickle Cell Disease, Headache, and Difficulty Speaking
Presentation of Case. Dr. Todd M. Herrington (Neurology): A 22-year-old right-handed man was admitted to this hospital because of the acute onset of headache and difficulty speaking. The patient had been well until approximately noon on the day of admission, when a dull, diffuse headache developed;…
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Carotid–Cavernous Sinus Fistula
Figure 1.
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Extended-Release Naltrexone to Prevent Opioid Relapse in Criminal Justice Offenders
Opioid-use disorder is a chronic relapsing condition that has serious public health consequences. Opioid dependence disproportionately affects U.S. criminal justice system populations, and relapse and overdose deaths occur at high rates after release from incarceration. Evidence-based opioid…
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Opioid Abuse in Chronic Pain — Misconceptions and Mitigation Strategies
Chronic pain not caused by cancer is among the most prevalent and debilitating medical conditions but also among the most controversial and complex to manage. The urgency of patients' needs, the demonstrated effectiveness of opioid analgesics for the management of acute pain, and the limited…
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Case 10-2016: A 22-Year-Old Man with Sickle Cell Disease, Headache, and Difficulty Speaking
Presentation of Case. Dr. Todd M. Herrington (Neurology): A 22-year-old right-handed man was admitted to this hospital because of the acute onset of headache and difficulty speaking. The patient had been well until approximately noon on the day of admission, when a dull, diffuse headache developed;…
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Carotid–Cavernous Sinus Fistula
Figure 1.
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Perceptions of Urologists About the Conversational Elements Leading to Treatment Decision-Making Among Newly Diagnosed Prostate Cancer Patients
Abstract
Widespread adoption and use of the practice of shared decision-making among health-care providers, especially urologists, has been limited. This study explores urologists' perceptions about their conversational practices leading to decision-making by newly diagnosed prostate cancer patients facing treatment. Semi-structured, in-depth interviews were conducted with 12 community and academic urologists practicing in the St. Louis, MO, region. Data were analyzed using a consensus coding approach. Urologists reported spending 30–60 min with newly diagnosed prostate cancer patients when discussing treatment options. They frequently encouraged family members' involvement in discussions about treatment, especially patients' spouses and children. Participants perceived these conversations to be difficult given the emotional burden associated with a cancer diagnosis, and encouraged patients to postpone their decisions or to get a second opinion before finalizing their treatment of choice. Initial discussions included a presentation of treatment options relevant to the patient's condition, side effects, outcome probabilities, and next steps. Urologists seldom used statistics while talking about treatment outcome probabilities and preferred to explain outcomes in terms of the patient's practical, emotional, and social experiences. Their styles to elicit the patient's preferences ranged from explicitly asking questions to making assumptions based on clinical experience and subtle patient cues. In conclusion, urologists' routine conversations included most elements of shared decision-making. However, shared decision-making required urologists to have nuanced discussions and be skilled in elicitation methods and risk discussions which requires further training. Further research is required to explore roles of family and clinical staff as participants in this process.
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Carotid–Cavernous Sinus Fistula
Figure 1.
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Case 10-2016: A 22-Year-Old Man with Sickle Cell Disease, Headache, and Difficulty Speaking
Presentation of Case. Dr. Todd M. Herrington (Neurology): A 22-year-old right-handed man was admitted to this hospital because of the acute onset of headache and difficulty speaking. The patient had been well until approximately noon on the day of admission, when a dull, diffuse headache developed;…
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Asparagus cochinchinensis Extract Alleviates Metal Ion-Induced Gut Injury in Drosophila: An In Silico Analysis of Potential Active Constituents
Metal ions and sulfate are components of atmospheric pollutants that have diverse ways of entering the human body. We used Drosophila as a model to investigate the effect of Asparagus cochinchinensis (A. cochinchinensis) extracts on the gut and characterized gut homeostasis following the ingestion of metal ions (copper, zinc, and aluminum). In this study, we found that the aqueous A. cochinchinensis extract increased the survival rate, decreased epithelial cell death, and attenuated metal ion-induced gut morphological changes in flies following chronic exposure to metal ions. In addition, we screened out, by network pharmacology, six natural products (NPs) that could serve as putative active components of A. cochinchinensis that prevented gut injury. Altogether, the results of our study provide evidence that A. cochinchinensis might be an effective phytomedicine for the treatment of metal ion-induced gut injury.
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Case 10-2016: A 22-Year-Old Man with Sickle Cell Disease, Headache, and Difficulty Speaking
Presentation of Case. Dr. Todd M. Herrington (Neurology): A 22-year-old right-handed man was admitted to this hospital because of the acute onset of headache and difficulty speaking. The patient had been well until approximately noon on the day of admission, when a dull, diffuse headache developed;…
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