Regulation of emotional response in juvenile monkeys treated with fluoxetine: MAOA interactions.

Juvenile male rhesus macaques received therapeutic doses of fluoxetine daily from one to three years of age and were compared to vehicle-treated controls (N=16/group). Genotyping for monoamine oxidase A (MAOA) polymorphisms was used to form subgroups (N=8) with high and low expression of the gene. Behavioral responses were scored during 30-second exposures to pictures differing in affective content. As expected from its therapeutic effect, fluoxetine decreased the behavioral response to emotionally evocative pictures. A 44% reduction in number of expressive behaviors was seen, but only in subjects with low expression MAOA polymorphisms. In general, this effect occurred for pictures of varying affective content and was not due to altered occurrence of one specific behavior or type of behavior. The drug*genotype interaction was seen after one and two years of treatment and did not reverse one year after discontinuation of dosing. Two potential translational implications are suggested: (1) MAOA genetic polymorphisms may be the source of some of the variability in response to fluoxetine treatment in children; (2) extended fluoxetine treatment during juvenile brain development may result in persistent effects on emotional regulation.

Hodgkin's lymphoma: an isolated case of involvement of the ureter.

We report the case of a man in which a Hodgkin's lymphoma involved the ureter as the very first clinical situs of the disease. Ureteral involvement in lymphomas is very rare (0.86%-7% and 1%-16%, found in two studies, respectively, of cases of patients with lymphoma examined post mortem) and when it does occur it is secondary to renal involvement or retroperitoneal adenopathies. It is by all means exceptional as an isolated situs of disease. Those cases reported in the literature as presenting lymphomatous involvement of the ureter have always been diagnosed as Non-Hodgkin's lymphomas.

Comparison of the diagnostic performance of high-frequency ultrasound as a first- or second-line diagnostic tool in non-palpable lesions of the breast.

To compare the diagnostic performance of high-frequency ultrasound (HFU) as a first- or second-line diagnostic tool in non-palpable lesions (NPL) of the breast and to define the place of HFU in the diagnostic process, 89 women with this kind of lesion, previously detected by mammography, underwent HFU with 7.5-13 MHz transducers. The examinations were performed by two equally experienced operators of which only one (operator I) was aware of the mammographic findings. The mammographic examinations revealed the following non-palpable lesions: asymmetry-hyperdensity (17 cases), nodule (44 cases), stellate lesion (5 cases), microcalcifications (23 cases). Total sensitivity of HFU in the examinations performed by operator I was 83 %, while in the examinations performed by operator II (unaware of the mammographic findings) it was only 35 %. In all cases HFU allowed the operators to determine the basic features of the lesions. Our experience confirms that ultrasonography, even if performed with high frequency, cannot be proposed as a screening examination but may profitably be employed as a second-step technique to characterize NPL previously identified by mammography. This 'second-step' role can do the following: rule out true pathology (cases of false-positive mammography findings); furnish some basic features in the case of focal lesions; show other findings in the case of microcalcifications, such as microcysts, 'filled duct' appearance, parenchymal inhomogeneities and nodules; guide interventional procedures; and localize lesions preoperatively.

Spontaneous epidural emphysema and pneumomediastinum during an asthmatic attack in a child.

CT revealed the presence of epidural emphysema as an incidental finding in a 13-year-old boy in whom mild infrequent coughing during an asthmatic attack resulted in a pneumomediastinum and subcutaneous emphysema. Epidural emphysema was not associated with neurological symptoms. The CT images demonstrated the pathway of air leakage from the posterior mediastinum through the intervertebral foramina into the epidural space. Repeat CT showed spontaneous resolution of the epidural emphysema.

[The neonatal respiratory insufficiency syndrome: the role of the chest radiogram]. / Sindrome da insufficienza respiratoria neonatale: ruolo del radiogramma del torace.

INTRODUCTION: Chest radiography is considered the most reliable diagnostic tool to study the respiratory distress syndrome in newborns and one of the few diagnostic investigations which can be used considering the clinical situation of these patients and the need of a prompt diagnosis. MATERIALS AND METHODS: We examined 124 newborns (56 males and 68 females) submitted to chest radiography at least once. Two radiologists analyzed the images investigating: a) chest expansion, b) reticulonodular opacities, c) aerial bronchograms, d) parenchymal consolidation, e) atelectasis, f) pneumothorax. The clinical diagnosis was made by neonatologists on the basis of clinical and instrumental data and of the clinical evolution of the patients. RESULTS: Twenty of 23 clinically negative patients had negative chest radiographs and 3 were false positives. Transient tachypnea was diagnosed in 14 newborns where chest radiography showed reticulonodular opacities. Ten of 62 patients with hyaline membrane disease had a negative chest radiograph, 26 had fine granular opacities, 16 marked hypoexpansion with reticulonodular opacities and aerial bronchogram, and 10 diffuse parenchymal consolidations with aerial bronchogram also in the peripheral lung. Eleven patients had a clinical and radiological diagnosis of segmental or lobar atelectasis; 5 newborns had an aspiration syndrome and radiography showed parenchymal consolidations in 4 and was negative in one. Five patients had pneumothorax, 3 diaphragmatic hernia and 1 infective pneumonia; radiology confirmed the diagnosis in all cases. We had three false positives and 11 false negatives at conventional radiography--i.e., 10 had MMI and one the meconium aspiration syndrome. Diagnostic sensitivity was 89.1%, specificity 86.9% and diagnostic accuracy 88.7%. CONCLUSIONS: Our results are partially limited by the lack of a reference gold standard. Nevertheless, if we consider the clinical condition and the respiratory distress syndrome evolution as a valid reference, the diagnostic accuracy of radiography is good.

[Urotheliomas of the upper urinary tract. The role of computed tomography in integrated diagnostic imaging]. / Uroteliomi delle vie escretrici urinarie superiori. Ruolo della Tomografia Computerizzata nella diagnostica per immagini integrata.

INTRODUCTION: Transitional cell carcinomas are frequent in the bladder but rare in the renal pelvis. Most upper urinary tract cancers are suspected and detected with urography and retrograde pyelography; CT is important in the questionable cases at US, urography and retrograde pyelography, but it is also useful to detect locoregional disease. We report the findings of 35 patients, with ureteral lesions to assess the role of CT in the diagnosis and staging. MATERIALS AND METHODS: Thirty-five patients were examined with US and CT; 27 underwent urography, 16 retrograde pyelography and 4 nephrostomic pyelography, CT staging was made with Hahn's criteria related to TNM (stages CT I, CT II, CT III). All patients underwent surgery and the histologic findings were compared with CT staging. RESULTS: CT detected all lesions and characterized them from a morphological viewpoint (intraluminal minus, wall thickening). Using Hahn's CT staging we obtained agreement with histologic findings in 21 of 23 cases in CT stage I, six of 10 in CT stage II and 4 of 5 in CT stage III. CONCLUSIONS: CT is an important tool for both diagnosis and therapy because it shows the renal cavities and parenchyma and permits accurate staging, differentiating the tumors localized in the wall from those with local spread or distant metastases. In our experience, CT is not useful to differentiate mucosal from pelvic-ureteral muscle invasion but peripelvic and periureteral fat invasion can be suspected when the infiltrated wall exhibits an irregular and spiculated profile.