Application of intravoxel incoherent motion (IVIM) magnetic resonance imaging in the evaluation of primitive brain tumours.

Intravoxel incoherent motion is a potential non-invasive diagnostic tool in brain tumours, without any clear guidelines for its evaluation yet. In our study, we compare intravoxel incoherent motion with dynamic susceptibility contrast magnetic resonance imaging in the quantification of tumour tissue blood perfusion in 28 patients affected by brain tumours, highlighting the issues encountered during the acquisition set-up and post-processing steps. Intravoxel incoherent motion is a new imaging tool and an alternative technique to dynamic susceptibility contrast-magnetic resonance imaging which is of considerable interest at present. This is partly because it does not require the use of a contrast agent and relies on the intrinsic properties of motion in the capillaries of the spins. Compared to dynamic susceptibility contrast-magnetic resonance imaging, the intravoxel incoherent motion technique is also characterised by better resolution because the gadolinium-based contrast agent bolus used in the standard technique results in a variation by more than 50% of the signal coming from the brain. Finally, intravoxel incoherent motion is more sensitive to the incoherent motion that originates from small capillary vessels, while the dynamic susceptibility contrast signal is also contaminated by the input from larger arteries and veins, which may result in an overestimation of the blood volume. Although there are limitations due to the heterogeneity of the sample considered in our study, intravoxel incoherent motion has been shown to be an accurate noninvasive radiological biomarker, useful to distinguish between low and high grade glial tumours.

[Antibiotic prophylaxis in prostate biopsy]. / La profilassi antibiotica nell'agobiopsia prostatica.

INTRODUCTION: Prostate biopsy is nowadays one of the most frequent diagnostic procedures in urology. The incidence of bacteraemia, bacteriuria and infective complications is higher after the transrectal procedure than after the transperineal one. A survey demonstrated that 98% of the urologists in USA use antibiotics to prevent infective complications. The transrectal prostate biopsy is the only diagnostic intervention procedure in urology for which an antibiotic prophylaxis is recommended, also for low-risk patients, by the guidelines of the European Association of Urology. If the perineal route is adopted, the antibiotic prophylaxis is recommended only in high-risk patients. MATERIALS AND METHODS: The patient should preferably receive an evacuative enema to achieve a rectal cleansing and to ameliorate the diagnostic accuracy of transrectal ultrasound. A survey in the US demonstrated that an evacuative enema with saline solution is adopted by more than 80% of urologists. Criteria for antibiotics choice. The majority of bacteraemias are transitory, asymptomatic and self-limiting. On the other side, bacteriuria can persist for several days. Antibiotics must achieve high drug concentrations not only in plasma and tissue but also in urine. Symptomatic infections are generally caused by E. Coli and less frequently by the Streptococcus faecalis. Nevertheless, other agents as Klebsiella and Chlostridium, although rare, might cause severe infections. Thus, prophylaxis needs antibiotics at large spectrum and a single agent may not be enough for high-risk patients. Risk determination and drug schedules. It is essential to point out the infective risk of the patient. The choice of the drug, the timing and schedule of antibiotic prophylaxis are still object of debate. Several randomized studies have been conducted with contradictory results. RESULTS: The antibiotic prophylaxis should be tailored according to patients? infective risk and to the procedure adopted. It is able to reduce infections rate after transrectal biopsy below 5%. The adoption of periprostatic anesthesia and the number of cores can influence the incidence of infective complications. Commonly, one-three days oral administration of fluoroquinolone is adopted. A single-dose prophylaxis can be also used with favorable results. Tolerability and route of administration should be taken into account, and also costs should be considered. CONCLUSIONS: Considering the low cost of antibiotics adopted as short-term prophylaxis and the high cost of the treatment of infective complications, it seems reasonable to provide antibiotics prophylaxis for all patients at high risk for infective complications and for all cases submitted to transrectal prostate biopsy.

PSA reduction (after antibiotics) permits to avoid or postpone prostate biopsy in selected patients.

Microscopic foci of prostatitis may induce prostate-specific antigen (PSA) increase. PSA reduction after antibiotics might identify those patients in whom biopsy can be avoided. Ninety-nine patients received ciprofloxacin for 3 weeks, of whom 59 showed PSA reduction. Histology detected small foci of prostatitis in 65% of cases. Carcinoma was found in 40 and 20.3% of patients with unchanged or decreased PSA, respectively (P=0.03). No cancer was detected if PSA decreased below 4 ng/ml or more than 70%. Biopsy can be postponed, with a low risk of missing a cancer, if PSA decreases more than 70% or below 4 ng/ml.

Evaluation of an early childhood programme based on principles of conductive education: the Yooralla project.

OBJECTIVE: To perform an objective evaluation of a programme based on conductive education (CE) for preschool and early school-aged children with cerebral palsy. METHODOLOGY: The progress of 17 children participating in a CE-based programme (the Yooralla programme) was compared with 17 children enrolled in traditional early childhood services. Videotapes of the children performing items from the Vulpe Assessment Battery (VAB) were scored by assessors blind to the treatment group; three standardized tests of cognitive ability were administered; and the questionnaire on resources and stress (QRS-F) was given to the primary caregiver at the beginning and conclusion of 6 months. RESULTS: The Yooralla group improved in motor performance and parental coping variables. Both groups showed improvement on the cognitive measures, with the control group demonstrating slightly greater gains. CONCLUSIONS: Conductive education may benefit the motor development of children with cerebral palsy and provide greater parental support. A randomized control study with adequate subject numbers is necessary to confirm this tentative conclusion.

Effect of patient positioning on urethral mobility: implications for radical pelvic surgery.

Patient positioning is of critical importance in the successful performance of several radical pelvic operations. Adequate exposure of the prostatic apex is vital in ligating the dorsal vein complex and performing vesicourethral anastomosis. To test the effect of different patient positions on urethral mobility, we conducted a prospective controlled study measuring the relative cephalad displacement of the prostatic apex in 3 positions, that is the supine, frog-leg and dorsal lithotomy positions. A combination of radiographic and cystoscopic techniques was used to mark the position of the prostatic apex. Each patient served as his own control. Of the 24 patients studied for a variety of urological complaints 19 (79%) had an increased cephalad displacement of the prostatic apex while in the frog-leg position compared with the dorsal lithotomy position. The mean gain was 0.5 cm. (p greater than 0.5). A total of 16 patients showed improvement while in the frog-leg position over the supine position with a mean advantage of 0.39 cm. (p greater than 0.05). Patient age, pelvic depth, pelvic circumference and prostatic urethral length had no predictive value in selecting an optimal position.

Staphylococcus aureus pneumonia in hamsters with elastase-induced emphysema--the virulence enhancing activity of mucin.

Staphylococcus aureus pneumonia was studied in hamsters with elastase-induced emphysema and in saline-treated controls. Emphysematous animals cleared endotracheally administered inocula of S. aureus in saline as rapidly as controls. After infection with S. aureus in 1% mucin, emphysematous animals had impaired clearance compared with controls; after infection with S. aureus in 5% mucin, emphysematous animals had decreased survival at 96 hr compared to controls (6/24 vs 15/24, P less than 0.01 Fisher's exact test). Bronchoalveolar lavage of uninfected elastase-treated hamsters yielded twice as many cells per animal as uninfected controls (P less than 0.0001, paired t test), and the cells contained a higher percentage of polymorphonuclear leukocytes (37.8% vs 3.8%, P less than 0.0001). Lavage cells from both groups of animals were equally efficient per cell at killing opsonized S. aureus in an in vitro bactericidal assay. Hamsters with elastase-induced emphysema were resistant to infection with S. aureus alone despite marked structural abnormalities in the lung, possibly due in part to increased numbers of resident phagocytic cells. After infection with S. aureus in mucin as a virulence enhancing factor emphysematous animals had impaired clearance and decreased survival compared to controls.

AIDS and germ cell tumors of testis.

A retrospective analysis of all testicular tumors treated at our institution over a seven-year period was conducted. Twenty-five of 115 patients were found to have acquired immune deficiency syndrome (AIDS), AIDS-related complexes, or to be at risk for AIDS developing. Non-seminomatous germ cell tumors were more common in the AIDS group.

Postpartum renal vein thrombosis with left retroaortic renal vein.

An unusual case of thrombosis in a left retroaortic renal vein is presented. Noninvasive radiologic diagnosis is reviewed.

Total replacement of bladder and urethra by cecum and appendix in bladder exstrophy.

The first case of total bladder and urethral replacement by cecoappendiceal unit was achieved in a five-year-old boy born with bladder exstrophy. Residual vesical and prostatic tissue was utilized to provide continence successfully.

Young hamsters are more resistant than adults to endotracheally instilled porcine pancreatic elastase.

We measured the physiologic and stereologic response to 0.1, 0.2, and 0.4 microgram of porcine pancreatic elastase instilled in a volume of 0.25 ml 0.9% NaCl/100 g body weight into the trachea of groups of young and adult hamsters. The young hamsters averaged 50 g and the adult hamsters 116 g in initial body weight. Twenty-one days after administration of elastase, lung volumes, static lung compliance, maximum expiratory flow, the whole section mean linear intercepts (MLI) were measured. The degree of emphysema increased in all animals as a function of dose. Examination of the lung volume and compliance dose-response characteristics indicated that young hamsters developed less physiologic change with increasing elastase dose than did adult hamsters. Maximum expiratory flow and whole section MLI dose-response were similar in the young and adult elastase-treated groups. However, the MLI in young hamsters treated with the 0.4 microgram elastase dose was decreased in the outer third of the lung compared to adult emphysematous hamsters. Also, mean airspace density relative to saline control values in young hamsters was double that found in adult hamsters treated with the 0.4 microgram elastase dose. Although serum alpha 1-globulin levels were equivalent in both young and adult normal hamsters, values normalized for lung elastin content were significantly increased in young animals. We conclude that young hamsters show less change in lung function as a function of elastase dose twenty-one days after elastase instillation. Possible reasons for this include an increased ratio of lung alpha 1-globulin/lung elastin in young hamsters, their continued ability to grow new alveoli, and age related differences in airway size favoring a central distribution of enzyme.

Eglin-c, a polypeptide derived from the medicinal leech, prevents human neutrophil elastase-induced emphysema and bronchial secretory cell metaplasia in the hamster.

Eglin-c (Eg-c), a polypeptide with a molecular mass of 8,100 daltons, was purified from the medicinal leech Hirudo medicinalis. The Eg-c was tritiated by reductive methylation for in vitro studies. Incubation of 2.1 X 10(-10) moles of human neutrophil elastase (HNE) with 3H-elastin in the presence of 8.2 X 10(-10) moles of 3H-Eg-c inhibited 98.7% of the elastolytic activity of the enzyme. Using Sephadex G 100 chromatography and 1.7 moles of 3H-Eg-c per mole of HNE, a 34,000-dalton complex (3H-Eg-c-HNE) was observed. The stability of the complex formed between 3H-Eg-c and HNE that had been inactivated with succinyl-ala2-pro-val CH2Cl was much less than that of the 3H-Eg-c-HNE complex. In vivo studies were carried out in weight-matched groups of anesthetized golden Syrian hamsters given 100, 300, 500, or 2,000 micrograms of Eg-c in 0.5 ml saline intratracheally 1 h before 300 micrograms HNE was administered intratracheally. Control animals received saline followed by HNE or 2 doses of saline 1 h apart. Eight weeks later, lung statics and dynamics were measured in anesthetized animals, followed by histologic study of lung parenchyma and the mucosa of the large intrapulmonary airways. There were no deaths, and final mean body weights were similar in all groups.(ABSTRACT TRUNCATED AT 250 WORDS)

Effect of combined human neutrophil cathepsin G and elastase on induction of secretory cell metaplasia and emphysema in hamsters, with in vitro observations on elastolysis by these enzymes.

To determine whether purified human neutrophil cathepsin G (Cat-G) can act by itself or in concert with purified human neutrophil elastase (HNE) in the induction of emphysema and bronchial secretory cell metaplasia (SCM), we gave golden Syrian hamsters 100 micrograms of HNE alone or in combination with either 100 or 200 micrograms of Cat-G. Other groups of animals received intratracheal doses of up to 600 micrograms of Cat-G alone. The severity of emphysema was determined from measurements of lung volumes, compliance, forced expiratory flow, and the mean linear intercept. The severity of SCM in the main airways was graded on sections stained by the alcian blue and periodic acid-Schiff reaction. The Cat-G was a weak inducer of SCM; significant SCM was produced by 400 and 600 micrograms but not by 100 or 200 micrograms or 200 micrograms of Cat-G. The Cat-G (100 and 200 micrograms) did not potentiate the SCM induced by 100 micrograms of HNE. The Cat-G alone did not produce emphysema, and neither 100 nor 200 micrograms of Cat-G potentiated the mild emphysema induced by 100 micrograms of HNE. These results were not consonant with a report that Cat-G and HNE were synergistic in solubilizing human lung elastin. We therefore measured the ability of Cat-G and HNE to solubilize several radiolabeled elastins. The combination of Cat-G and HNE did not solubilize significantly more hamster lung elastin (23%) than the sum of their individual activities.(ABSTRACT TRUNCATED AT 250 WORDS)

Head-position training through biofeedback: prosthetic or cure?

This report investigates the effectiveness of biofeedback in the treatment of poor head-positioning in patients with cerebral palsy. Four patients were given feedback of head-position trainer: two were given 20 sessions, the other two were given 10 sessions followed by 10 sessions of social reinforcement. It was found that biofeedback produced significant changes in head control during therapy but that these did not transfer well to other situations, nor did it result in long-term positive improvement. The use of social reinforcement produced excellent and long-term gains. These results are discussed in terms of stimulus properties and reinforcement conditions. General implications of this study in relation to the generalisation and maintenance of behaviour change are also discussed.

Emphysema and bronchial secretory cell metaplasia induced in hamsters by human neutrophil products.

Purified human neutrophil elastase (HNE) and a crude extract of human neutrophils (EXT) were administered intratracheally to hamsters, and their effects were determined 21 and 56 days later by measurement of lung statics and dynamics and by light microscopy and morphometry of the lungs. A dose of 450 micrograms of HNE (HNE 450) produced focal emphysema of moderate severity. The combination of HNE 450 and EXT (HNE 450 + EXT) produced no more severe emphysema than HNE 450 alone; EXT alone did not produce emphysema. The HNE 450, HNE 450 + EXT, and EXT all produced persistent secretory cell metaplasia in large intrapulmonary airways. In a second experiment, 40 micrograms of HNE (elastolytic activity equivalent to that in EXT), designated HNE 40, did not produce secretory cell metaplasia. Neither EXT nor EXT treated with the elastase inhibitor suc-ala-ala-pro-val chloromethyl ketone (EXT + CMK), which had a residual elastolytic activity equivalent to 15 micrograms of HNE, produced emphysema; both preparations caused bronchial secretory cell metaplasia 21 days after treatment. Values of maximal expiratory flow, measured 21 days after treatment, were reduced at points between 20 and 50% of vital capacity for HNE 450 and between 30 and 80% of vital capacity for HNE 450 + EXT; maximal expiratory flows were not significantly different from saline controls for HNE 40, EXT, or EXT + CMK.(ABSTRACT TRUNCATED AT 250 WORDS)

The balance of lung connective tissue elements in elastase-induced emphysema.

Elastase-induced emphysema is associated with changes in all components of connective tissue, including elastin. The abnormal restructuring of lung parenchyma that occurs after elastase administration in hamsters might reflect an abnormal balance of elastin, collagen, and glycosaminoglycan in lung parenchyma. To test this hypothesis, we measured total amounts and levels of accumulation over 24 hr of connective tissue elements in lung explants at several points over a 1-year period after a single elastase treatment in hamsters. We found acute, early changes in the metabolism of elastin, collagen, and glycosaminoglycan consistent with degradation of elastin and increased turnover of collagen and glycosaminoglycan. By day 21 after elastase treatment, lung elastin had returned to control values, then rose and stayed elevated throughout the remainder of the study period. Total collagen levels rose in both control and elastase-treated lungs by the same amount over the year period. However, incorporation of 14C-proline into collagen hydroxyproline was elevated only in elastase-treated lungs over the period of 21 to 360 days. Incorporation of 14C-glucosamine into glycosaminoglycan was greatest over the period of 1 to 5 days after treatment and total levels also peaked at this time. By day 21 both incorporation of glucosamine and total levels of glycosaminoglycan had returned to normal, where they remained. The ratios of glycosaminoglycan to elastin and glycosaminoglycan to collagen were calculated over the period of 21 to 360 days to determine whether the long-term relative balance of these components had changed in elastase-treated lungs. We found that a steady-state imbalance existed between heparan sulfate and collagen and heparan sulfate and elastin, suggesting that an inappropriate amount of heparan sulfate was present relative to the amounts of collagen and elastin. We conclude that administration of elastase results in changes in the long-term balance of lung connective tissue components.