The use of low dose CT scouts for MR safety screening: A multi-reader evaluation.

INTRODUCTION: Plain film radiographs are recommended to assist in MRI safety screening of patients with unknown medical histories, especially in an emergency setting where patients might be unable to answer a safety questionnaire. This study assesses the performance of CT scout images, which have low radiation dose and are faster and easier to acquire compared to plain film radiographs, in finding and naming a range of head and body implants. METHODS: A retrospective analysis of 40 CT Head and Neck (HN) scout images and 40 CT Chest, Abdomen and Pelvis (CAP) scout images was undertaken. A subset of these were chosen to include a range of common internal implants not identifiable externally to the patient. The images were assessed by three readers with varying levels of clinical experience in MRI who were asked to find and name any implants seen. RESULTS: Collectively, all readers reached a sensitivity of 85 % in finding internal implants, regardless of their clinical experience or experience in reviewing CT images, and a minimum specificity of 95 %. Implants were correctly named in 74 % of the images presented. CONCLUSION: CT scout images were able to reveal most of the implants included. However, clinical experience in reviewing the images enhances a reader's ability to identify the type of implant. IMPLICATIONS FOR PRACTICE: In an emergency setting, imaging can be critical in the management of patients presenting with acute illnesses. In the unconscious or unresponsive patient, the use of CT scouts, where this is the only option available, could provide valuable MRI safety information prior to a scan, improving access to the MRI scan in a timely manner.

'Black Bone' magnetic resonance imaging as a novel technique to aid the pre-operative planning of posterior tympanotomy for cochlear implantation.

Purpose: 'Black Bone' magnetic resonance imaging (BB MRI) is a novel sequence developed as an alternative to computed tomography (CT) for osseous imaging. We explored its potential utilisation in the pre-operative surgical planning of posterior tympanotomy for cochlear implantation through depiction of the mastoid facial nerve (mFN) canal and the posterior canaliculus of the chorda tympani (ChT), thus defining the facial recess. Methods: Twenty five adult patients were prospectively imaged with a dedicated BB MRI sequence. A consensus qualitative BB MRI 'visibility score' for the confidence of demonstration of the mFN canal and the posterior canaliculus of the ChT was recorded, as well as a 'corresponding score' to determine whether the neural structures on BB MRI corresponded to the paths of the nerves on a previous CT study. Results/discussion: The BB MRI sequence was able to clearly delineate the course of mFN in 100% of cases and that of ChT in 72%, with their courses corresponding to those depicted on CT in almost all cases. Maximum intensity projections with 7 mm slabs provided the optimal simultaneous demonstration of mFN, ChT and round window along the posterior tympanotomy surgical approach. Conclusion: The proposed BB MRI sequence reliably depicts mFN and ChT in the majority of cases, with a performance comparable to that of CT. It is proposed that it will be a useful adjunct to MRI protocols as part of cochlear implant assessment in those centres where CT is not routinely performed.

Spontaneous rupture of the digital extensor tendons of the hand in unrecognized carpal lunatefracture.

Spontaneous rupture of the digital extensor tendons of the hand has been reported after Kienbocks disease, rheumatoid arthritis, Vaughan-Jackson syndrome, distal radial fracture. Rupture may also occur as a consequence of unrecognized carpal lunate fracture. We present a case report of a man affected with spontaneous rupture of the digital extensor tendons secondary to unrecognized carpal lunate fracture with partial dorsal dislocation. The edges of the tendon were debrided and sutured using a locked modified Kessler suture. A dynamic splinting cast was applied in moderate extension of the wrist. The aim of this case report is to highlight that in absence of a clear etiology for rupture of the extensor tendons of the hand, carpal lunate fracture, though rare, is an important cause of spontaneous extensor tendons rupture.

La ruptura espontánea de tendones extensores digitales de la mano ha sido reportado después de la enfermedad de Kienböck, artritis reumatoide, síndrome de Jackson Vaughan, fractura del radio distal. La lesión del tendón también puede ocurrir como consecuencia de la fractura no reconocida de carpal semilunar. En este artículo, se presenta un caso de un hombre que sufre de rotura espontánea del tendón extensor digital secundaria a fractura semilunar no reconocida de los huesos del carpo con luxación dorsal del fragmento parcial. Los bordes del tendón se han limpiado y se sutura usando una sutura de Kessler. Un refuerzo dinámico se aplicó en extensión moderada de la muñeca. El propósito de este caso clínico es poner de relieve que, en ausencia de una etiología clara de la ruptura de los tendones extensores de la mano, una fractura de los huesos del carpo semilunar puede ser una causa importante de la ruptura espontánea de los tendones extensores de la mano.

Spontaneous rupture of the digital extensor tendons of the hand in unrecognized carpal lunatefracture / Ruptura espontánea de los tendones extensores de los dedos de la mano en una fractura oculta del semilunar

Abstract: Spontaneous rupture of the digital extensor tendons of the hand has been reported after Kienbock's disease, rheumatoid arthritis, Vaughan-Jackson' syndrome, distal radial fracture. Rupture may also occur as a consequence of unrecognized carpal lunate fracture. We present a case report of a man affected with spontaneous rupture of the digital extensor tendons secondary to unrecognized carpal lunate fracture with partial dorsal dislocation. The edges of the tendon were debrided and sutured using a locked modified Kessler suture. A dynamic splinting cast was applied in moderate extension of the wrist. The aim of this case report is to highlight that in absence of a clear etiology for rupture of the extensor tendons of the hand, carpal lunate fracture, though rare, is an important cause of spontaneous extensor tendons rupture.

Resumen: La ruptura espontánea de tendones extensores digitales de la mano ha sido reportado después de la enfermedad de Kienböck, artritis reumatoide, síndrome de Jackson Vaughan, fractura del radio distal. La lesión del tendón también puede ocurrir como consecuencia de la fractura no reconocida de carpal semilunar. En este artículo, se presenta un caso de un hombre que sufre de rotura espontánea del tendón extensor digital secundaria a fractura semilunar no reconocida de los huesos del carpo con luxación dorsal del fragmento parcial. Los bordes del tendón se han limpiado y se sutura usando una sutura de Kessler. Un refuerzo dinámico se aplicó en extensión moderada de la muñeca. El propósito de este caso clínico es poner de relieve que, en ausencia de una etiología clara de la ruptura de los tendones extensores de la mano, una fractura de los huesos del carpo semilunar puede ser una causa importante de la ruptura espontánea de los tendones extensores de la mano.

Breast dynamic contrast-enhanced examinations with fat suppression: are contrast-agent uptake curves affected by magnetic field inhomogeneity?

OBJECTIVES: To investigate the effect of magnetic field heterogeneity in breast dynamic contrast-enhanced examinations with fat saturation (DCE-FS). METHODS: The magnetic field was mapped over the breasts in ten patients. DCE-FS was undertaken at 1.5 T with fast spoiled gradient echoes and spectrally selective fat saturation. Signal intensity was calculated for T1 values 25-1,200 ms both on and off resonance, and results were verified with a test object. Clinical examinations were evaluated for the predicted effects of field heterogeneity. RESULTS: Magnetic field was found to vary by 3.6 ± 1.2 ppm over the central transaxial slice and 5.1 ± 1.5 over the whole breast volume (mean ± standard deviation). Computer simulations predict a reduction in the dynamic range if field heterogeneity leads to unintended water suppression, and distortion to CA uptake curves due to fat suppression failure (for fat containing pixels). A compromise between dynamic range and fat saturation performance is required. Both water suppression and fat suppression failure are apparent in clinical examinations. CONCLUSION: Magnetic field heterogeneity is likely to reduce the sensitivity of DCE-FS by distorting the CA uptake curves because of fat suppression failure (for fat containing pixels) and by reducing the dynamic range because of unintended water suppression. KEY POINTS: • Magnetic field heterogeneity is significant in breast magnetic resonance. • Contrast-agent uptake curves are distorted by a non-uniform magnetic field. • Radiologist must be aware of possibility of distortion to interpret uptake curves correctly. • Compromise between fat suppression and dynamic range is required.

A case of coloboma in a newborn to a woman taking mycophenolate mofetil in pregnancy after kidney transplantation.

Recently, mycophenolate mofetil (MMF) has been introduced in the immunosuppressive strategy after kidney transplantation. Recently, the existence of a MMF associated embriopathy has been hypothesized, namely, multiple craniofacial malformations. Only 1 report has described chorioretinal coloboma. We report a case of woman who used MMF throughout pregnancy after kidney transplantation. Her newborn developed coloboma of the right eye associated with an ocular cyst without any other malformation. The other drugs used by our patient are not considered teratogenic. Therefore, it seems reasonable to conclude a causal relationship between MMF and the malformation observed in this newborn.

Menkes disease: case report of an uncommon presentation with white matter lesions.

Menkes disease is a rare X-linked disorder related to a defect in the copper metabolism. According to the current literature, the most frequent neuroimaging findings are cortical atrophy, chronic subdural effusion or hygroma, and vascular abnormalities. White matter lesions may be present before other features of the disease and may evolve into atrophy. We hereby report a case of Menkes disease with typical history and progression, and an early phase imaging study with important white matter abnormalities, which could have lead to diagnostic difficulties.

Acute adrenal haemorrhage: diagnosis, treatment and follow-up.

Acute adrenal haemorrhage (AAH) is a rare disorder with different aetiologies. Aiming to discuss this condition, this report deals with four different cases that will be analysed and examined below, each one of them confirmed by biopsy or surgery and followed clinically and radiologically. In these cases it was found that the patients suffered from localized abdominal pain (4/4) and fever (2/4); one patient had adrenal insufficiency due to bilateral massive AAH. Therefore we concluded that AAH is an uncommon condition with variable clinical manifestations.

"In vitro" and in animal model studies on a double virus-inactivated factor VIII concentrate.

To improve the safety of plasma derived factor VIII (FVIII) concentrate, we introduced a final super heat treatment (100 degrees C for 30 min) as additional virus inactivation step applied to a lyophilized, highly purified FVIII concentrate (100 IU/mg of proteins) already virus inactivated using the solvent/detergent (S/D) method during the manufacturing process. The efficiency of the super heat treatment was demonstrated in inactivating two non-lipid enveloped viruses (Hepatitis A virus and Poliovirus 1). The loss of FVIII procoagulant activity during the super heat treatment was of about 15%, estimated both by clotting and chromogenic assays. No substantial changes were observed in physical, biochemical and immunological characteristics of the heat treated FVIII concentrate in comparison with those of the FVIII before heat treatment.

Factor VIII:c concentrate virus inactivated: progress in purification by using classic chromatographic methods.

This study was carried out with the aim of developing a production process for the manufacture of a highly purified factor VIII concentrate which is virus inactivated by pasteurization in liquid phase. Beside standard plasma protein separation techniques, the procedure uses a chromatographic step on anion exchanger, whose selectivity is increased by using high, but not destabilizing salt concentrations. The final product before stabilization has a specific activity higher than 300 IU/mg of protein, namely the highest specific activity reported for human factor VIII concentrates purified without the use of immunoadsorbents.

One-step immunoaffinity purification of bioactive human recombinant IL-1 beta with a monoclonal antibody directed to a well-exposed domain of the protein.

A monoclonal antibody (mAb) specific for human recombinant IL-1 beta (hu rIL-1 beta) was produced by immunizing BALB/c mice with hu rIL-1 beta purified with classical methods. This mAb recognizes an epitope within the highly hydrophylic fragment spanning amino acid 133-147. The affinity constant of this mAb towards IL-1 beta was determined by RIA. An affinity column was prepared by covalent binding of the mAb to Sepharose CL-4B. The column was capable of selectively binding hu rIL-1 beta produced in Escherichia coli directly from crude homogenates. The IL-1 beta protein yield was higher than 90% with a very good recovery of IL-1 beta biological activity. Moreover, the immunosorbent retained at least two thirds of its IL-1 beta-binding capacity after 20 cycles of purification.

Different conformation of purified human recombinant interleukin 1 beta from Escherichia coli and Saccharomyces cerevisiae is related to different level of biological activity.

Human recombinant interleukin 1 beta produced in Escherichia coli and in Saccharomyces cerevisiae was purified to homogeneity by a combination of ion exchange, gel filtration and hydroxylapatite column chromatography. The two proteins, both expressed in the mature form, differ in that the protein secreted from yeast is glycosylated and lacks the first four amino acids. The biological activity of IL-1 obtained from E. coli is comparable to that of the natural protein, while the protein produced from yeast showed very low specific activity. The analysis of the state of oxidation of the two cysteine residues present in the IL-1 molecule and the evaluation of the immunoreactivity of the two proteins have proved that a different conformation is at the basis of the different biological activity of the two proteins.

Use of ZetaPrep cartridge for the purification of human recombinant interleukin 1 beta.

Zetaprep mass ion-exchange media represent a rapid and efficient chromatographic tool in the separation of proteins, in place of the conventional agarose or cellulose-based gels. We adopted this method, combined with classical steps, to purify to homogeneity human recombinant interleukin 1 beta (IL-1 beta) produced from E. coli and from S. cerevisiae. An anion exchanger QAE-ZetaPrep was used to achieve a rapid partial purification of both proteins. The IL-1 beta purification was completed by gel permeation chromatography on Sephadex G-50. When the protein was produced from yeast, an intermediate chromatographic step on a hydroxylapatite column was also necessary. The isolated proteins proved to be homogeneous by electrophoresis and amino acid analysis. The biological activity of IL-1 beta produced by E. coli is comparable to that of the natural protein, while the protein produced by yeast showed very low specific activity.

Cloning and sequencing of the pertussis toxin genes: operon structure and gene duplication.

Pertussis toxin, a protein composed of five different subunits (S1, S2, S3, S4, and S5), is the major virulence factor of Bordetella pertussis. We have cloned and sequenced a DNA fragment of 4.7 kilobases that contains the genes coding for the five subunits. The genes are clustered within 3.2 kilobases in the following order: S1, S2, S4, S5, and S3. A sequence closely resembling Escherichia coli promoters is found only before the S1 gene, and a possible termination signal is present at the end of the S3 gene, which suggests that the pertussis toxin genes are organized in a single operon. A possible Shine-Dalgarno sequence is present before the S1 gene but not before the other four genes that 8-12 nucleotides upstream from the ATG codon show a new consensus sequence, 5'TCC(T)GG3', possibly involved in the regulation of translation. We have also found sequence homology between the S2 and S3 genes and their protein products indicating that gene duplication played a major role in the evolution of pertussis toxin.

[Anthropometric state of nutrition in students of various elementary and secondary schools in Ancona]. / Stato di nutrizione antropometrico degli studenti di alcune scuole elementari e medie di Ancona.

An anthropometric assessment was made of the nutritional state of children from Ancona elementary and middle schools. It was found that the girls had more body fat than the boys, though the latter, too, displayed values above those reported in U.S. and Italian studies. The view is expressed that this excess fat requires counteraction through nutritional education. Diet and physical exercise are known to be important in the prevention of degenerative diseases of a metabolic nature. Such prevention must be undertaken as soon as possible.