Subchondral bone circulation in osteoarthritis of the human knee.

OBJECTIVE: The hypothesis of this study is that human subchondral bone exhibits abnormal patterns of perfusion in osteoarthritis (OA) that can be characterized by kinetic parameters of blood flow using dynamic contrast enhanced (DCE) MRI. DESIGN: Fifteen subjects with advanced OA of the knee and seven control subjects without OA were studied at 1.5 T with DCE-MRI. Region of interest (ROIs) analysis of pharmacokinetic perfusion parameters were used to examine initial uptake and washout of the contrast agent in the lateral tibial plateau. RESULTS: Arterial and venous perfusion kinetics were abnormal in subchondral OA bone compared to those of normal controls. Time-intensity curves (TIC) exhibited delayed contrast clearance in OA knees compared to normal. Quantitatively, changes were observed in the kinetic parameters, kep, Akep, and kel. The mean kep and Akep were reduced in OA, compared to normal bone, indicating a reduction of arterial inflow and delayed signal enhancement. The kel in OA bone was lower than in normal bone, the negative kel indicating a reduction in venous outflow. The area under the TIC (AUC60) indicated greater residual contrast in OA bone. CONCLUSIONS: DCE-MRI can quantitatively assess subchondral bone perfusion kinetics in human OA and identify heterogeneous regions of perfusion deficits. The results are consistent with venous stasis in OA, reflecting venous outflow obstruction, and can affect intraosseous pressure, reduce arterial inflow, reduce oxygen content, and may contribute to altered cell signaling in, and the pathophysiology of, OA.

Health status of Afro-Asian refugees in an Italian urban area: a cross-sectional monocentric study.

OBJECTIVES: The recent sociopolitical events in the Mediterranean and Middle Eastern areas have significantly impacted international migration flows. As disease prevalence and type are different among western and Afro-Asian countries, physicians dealing with refugees should be aware of their specific health needs. We aimed at evaluating the health status and disease history of refugees at their arrival in the urban area of L'Aquila (Italy). STUDY DESIGN: This is a monocentric cross-sectional study. METHODS: Refugees hosted at the local reception center in L'Aquila (Italy) between July 2014 and December 2014 were cross-sectionally evaluated for anamnestic, clinical, and laboratory features. A subset of randomly selected participants underwent further assessments (screening for tuberculosis, hepatitis B/C, human immunodeficiency virus, syphilis; ambulatory blood pressure measurement [ABPM]) to better define their health status. RESULTS: Ninety-three adult male refugees (27.34 ± 7.41 years) from Africa (76%) and Asia (24%) were enrolled. Overall, the most prevalent diseases according to the International Statistical Classification of Diseases and Related Health Problems 10th revision affected the digestive tract (15.6%) and musculoskeletal apparatus (14.4%). The analysis by continent of origin did not show significant differences in the distribution of diseases, although a trend toward some differences was observed. African refugees had a significantly greater prevalence of viral hepatitis (hepatitis B virus, P = 0.004; hepatitis C virus, P = 0.007) compared with Asians. Hypertension, as detected by ABPM, was uncommon. No written vaccination history was available. CONCLUSIONS: Health issues of our sample of Afro-Asian refugees span both non-communicable and communicable diseases, requiring attention for the safety of the individual and the community. National health systems should provide adequate information and shared guidelines for health professionals regarding identification and management of refugees' health needs.

G1P3, an interferon- and estrogen-induced survival protein contributes to hyperplasia, tamoxifen resistance and poor outcomes in breast cancer.

Hormonally regulated survival factors can have an important role in breast cancer. Here we elucidate G1P3, a survival protein induced by interferons (IFNs), as a target of estrogen signaling and a contributor to poor outcomes in estrogen receptor-positive (ER(+)) breast cancer. Compared with normal breast tissue, G1P3 was upregulated in the malignant epithelium (50 × higher) and was induced by estrogen ex vivo. In accord with its overexpression in early stages of breast cancer (hyperplasia and ductal carcinoma in situ), in morphogenesis assays G1P3 enhanced the survival of MCF10A acinar luminal cells causing hyperplasia by suppressing detachment-induced loss of mitochondrial potential and apoptosis (anoikis). In cells undergoing anoikis, G1P3 attenuated the induction of Bim protein, a proapoptotic member of the Bcl-2 family and reversed the downmodulation of Bcl-2 protein. Downregulation of G1P3 induced spontaneous apoptosis in BT-549 breast cancer cells and significantly reduced the growth of ER(+) breast cancer cell MCF7 (P≤0.01), further suggesting its prosurvival activity. In agreement with its induction by estrogen, G1P3 antagonized tamoxifen, an inhibitor of ER in MCF7 cells. More importantly, elevated expression of G1P3 was significantly associated with decreased relapse-free and overall survival in ER(+) breast cancer patients (P≤0.01). Our studies suggest that elevated expression of G1P3 may perturb canonical tumor-suppressing activity of IFNs partly by affecting the balance of pro- and antiapoptotic members of Bcl-2 family proteins, leading to breast cancer development and resistance to therapies.

Estudio multicéntrico de prevalencia de síndrome metabólico en dos poblaciones de adolescentes con sobrepeso /obesidad y normopeso de 7 provincias de Argentina / Multicenter study on the prevalence of the metabolic syndrome in overweight/obesity and normal-weight adolescents in 7 provinces in Argentina

La obesidad y el síndrome metabólico (SM) epresentan un problema de Salud Pública. Objetivo: estimar a prevalencia y distribución del SM en adolescentes on sobrepeso/ obesidad (SP/OB) y normopesos (NP) y examinar variables asociadas a SM y sus componentes. métodos: estudio comparativo transversal, en dos grupos e adolescentes de 10 a 19 años de 7 provincias argentinas. se realizó una encuesta social, demográfica, de hábitos alimentarios, de actividad física (AF), examen físico y determinamos indicadores antropométricos y bioquímicos. resultados: se evaluó a 1.009 adolescentes, 398 varones (39,4%), 601 (59,6%) controles (NP) y 408 (40,4%) casos (SP/OB). La prevalencia de SM en los SP/OB fue de 40,3%. No estuvo presente en los NP. Se encontraron diferencias significativas para: antecedentes familiares de SP/OB, peso de nacimiento (PN), edad de la menarca, presencia de acantosis nigricans (AN), circunferencia de cintura (CC) mayor al punto de corte y las variables metabólicas de laboratorio. Los SP/OB presentaron mayor proporción de componentes de SM (3,7% hiperglucemia basal, 27,9% hiperinsulinemia, 53,2% HOMA elevado, 45,6% HDL bajo, 37,7% TG altos y 13,5% HTA). La CC correlacionó positivamente con: TA, TG, insulina, HOMA y el Score Z de IMC y negativamente con HDL. Todos los pacientes estudiados presentaron malos hábitos alimentarios y los adolescentes con SM menor tiempo de AF. Conclusiones: la obesidad es un determinante del SM (40%) y la grasa corporal central se asocia con sus componentes...

Dyspareunia associated with a pelvic digit.

A pelvic digit is a rare congenital anomaly and often an incidental radiographic finding. Here we present the first reported case of a 57-year-old Caucasian female with a pelvic digit and a chief complaint of dyspareunia. Radiographic studies and magnetic resonance imaging confirmed a stable bony excrescence from the inferior left ischium impinging on the pelvic floor. The patient underwent surgical removal of the pelvic digit without complications. Accurate diagnosis of pelvic lesions is necessary to guide treatment.

Pesquisa de trastornos alimentarios en jóvenes con diabetes tipo 1: estudio comparativo con población normal / Screening of eating disorders in adolescents with type 1 diabetes: a comparative study with a normal control group

Objetivo Pesquisar Trastornos alimentarios (TA) en fase preclínica en jóvenes con Diabetes Mellitus Insulinodependiente (DMID), comparar los resultados con población control (PC) sana del estudio de la Sociedad Argentina de Pediatría (SAP) Identificar la asociación con factores metabólicos y medio-ambientales. Métodos: Entre 12/2001 y 8/2003 pediatras diabetólogos de 13 centros del país encuestaron a 270 pacientes con DMID de ambos sexos de 10 a 19a. Se utilizaron como instrumentos el EDEQ (Questionary Eating Disorders Examination), modificado con 40 preguntas y 5 subescalas, para detectar pacientes sospechosos de TA y el EDE12 para la confirmación diagnóstica. El diagnóstico de TA se basó en el DSM-IV. Se tomó una encuesta demográfica y control metabólico de los pacientes diabéticos y se evaluó antropometría (Peso, Talla, Índice de Masa Corporal (IMC)). Los resultados se compararon con 1971 controles del estudio de la SAP evaluados de igual forma. Se aplicó Chi2, test de T, Test de Fisher, Anova. Un valor de p <0.05 se consideró significativo. Se utilizó el programa EpiInfo 6.04. Resultados: El 26.5% (72/270) fue sospechoso de tener TA vs. 19.2% (380/1971) de la PC (p=0.001). Encontramos 20% de varones diabéticos sospechosos que, comparados con la PC (12%) fue mayor (p=0.001). Encontramos mayor proporción de sospechosos entre las post-menárquicas (p 0.006), los pacientes con antecedentes de problemas alimentarios (p=0.001) y los que presentaron un IMC superior al Plo.90 (p=0.03). Completó el EDE-12 el 78% de los sospechosos (56/72) confirmando TA el 94.6% (53/56). Estos pacientes presentaron trastorno alimentario no especificado (TANE). De ellos, 48 (91%) llenaron criterio de trastorno compulsivo del comer (BED). No se diagnosticó ni anorexia nerviosa (AN) ni Bulimia nerviosa (BN). 15% (11) de los sospechosos manipuló insulina. La prevalencia de sobrepeso fue de 18.8% en diabéticos vs. 26.3% en PC (p NS) Conclusión: La frecuencia de sospecha de TA así como el diagnóstico de formas subclínicas es mayor que la encontrada en la PC y la citada por la literatura. El equipo tratante deberá estar alerta en especial en las púberes postmenárquicas, los pacientes con antecedentes de problemas alimentarios y aquellos con alto IMC (AU)

Objective: To screen eating disorders (ED) in the pre-clinical phase in adolescents with insulin-dependent diabetes mellitus (IDDM), to compare the results with a healthy control group (CG) of the Sociedad Argentina de Pediatría (SAP) study, and to identify associated metabolic and environmental factors. Methods: Between 12/2001 and 8/2003 pediatricians specialized in diabetes from 13 centers in Argentina interviewed 270 male and female patients with IDDM between 10 and 19 years. The QEDE (Questionnaire Eating Disorders Examination) was used, modified with 40 questions and 5 subscales, to detect patients with possible ED and the EDE12 to confirm the diagnosis. The diagnosis of ED was made using the DSM-IV. Demographic and anthropometric data (weight, height, body mass index (BMI)) were registered and the patients were metabolically controlled. The results were compared with the data of 1971 controls from the SAP study that were similarly assessed. Chi square test, T test, Fisher test, and Anova were used for the statistical analysis. A p value of <0.05 was considered significant. EpiInfo 6.04 was used. Results: Of the patients, 26.5% (72/270) was suspected of having an ED vs. 19.2% (380/1971) of the CG (p=0.001). Of the male IDDM patients, 20% was suspected of having an ED compared to 12% of the CG (p=0.001). We found a higher rate of suspected cases among post-menarche girls (p 0.006), patients with a history of eating disturbances (p=0.001), and those who had a BMI greater than the 90th percentile (p=0.03). Of the patients suspected of having an ED, 78% (56/72) filled out the EDE-12, confirming the ED in 94.6% of the cases (53/56). These patients presented with non-specified eating disorders (NOSED). Forty-eight 48 (91%) met the criteria of binge-eating disorder (BED). Neither anorexia nervosa (AN) nor bulimia nervosa (BN) was diagnosed. Fifteen percent (11) of those suspected having an ED manipulated insulin. The prevalence of overweight was 18.8% among the IDDM patients vs. 26.3% in the CG (p NS). Conclusion: Suspicion of ED and sub-clinical forms of ED was more frequent in the IDDM group than in the CG or than mentioned in the literature. The treating team should specially be alert in post-menarche adolescents, patients with a history of eating disturbances, and in those with a high BMI (AU)

Sensitivity and specificity of eight CT signs in the preoperative diagnosis of internal mesenteric hernia following Roux-en-Y gastric bypass surgery.

AIM: To evaluate the sensitivity and specificity of eight previously reported computed tomography (CT) signs in diagnosing internal mesenteric hernia following Roux-en-Y gastric bypass surgery. MATERIALS AND METHODS: Preoperative CT images of nine patients with surgically proven internal mesenteric hernia as a complication of gastric bypass surgery and 10 matched control patients were reviewed in a blinded fashion by three radiologists. The presence of eight previously reported signs of internal mesenteric hernia was assessed: mesenteric swirl sign, hurricane eye sign, mushroom sign, small bowel obstruction, clustered small bowel loops, small bowel other than duodenum located behind the superior mesenteric artery (SMA), presence of the jejunal anastomosis to the right of the midline, and engorged mesenteric lymph nodes. The sensitivity and specificity were calculated for each sign, as well as inter-observer reliability in recognizing these signs. RESULTS: Mesenteric swirl was the most predictive sign of internal hernia (sensitivity 78-100%, specificity 80-90%). Other CT signs showed good specificity (70-100%), but sensitivities were low (0-44%). The presence of a small-bowel obstruction and engorged mesenteric nodes was found to be 100% specific in predicting the presence of an underlying hernia. There was substantial inter-observer agreement in detecting mesenteric swirl sign (kappa=0.48-0.79), but agreement was relatively poor for all other signs. CONCLUSION: Mesenteric swirl is an easily recognized CT sign, and is the best indicator of internal hernia following Roux-en-Y gastric bypass surgery. Other reported CT signs are diagnostically insensitive. The presence of small-bowel obstruction with engorged mesenteric nodes is highly specific in diagnosing internal mesenteric hernia.

Obesidad en pacientes prepúberes: detección temprana de sindrome metabólico / Obesity in pre pubertal patients: early detection of a metabolic syndrome

El síndrome metabólico (SM) constituye una constelación de anormalidades metabólicas asociadas con resistencia insulínica y obesidad habiéndose demostrado que los individuos con síndrome de resistencia insulínica están en riesgo de desarrollar diabetes tipo 2 y enfermedad cardiovascular. De allí la importancia de detectar en forma precoz los individuos en riesgo e función de prevención. Nuesto objetivo fue estimar la prevalencia de los componentes del SM en una población de niños obesos prepúberes . Se estudiaron 197 niños obesos prepúberes, sin patología asociada, asistidos en el Servicio de Nutrición del Hospital Garrahan. El sin-drome metabólico se definió según los críterios propuestos por Organización Mundial de la Salud (OMS) adaptados a la edad pediátrica. La evaluación comprendió antropometría, examen físico, determinación de TA y estudios bioquímicos. Se realizó prueba de sobrecarga a la glucosa. Se midió glucemias e insulina plasmática basales y a lo 30-60-90-120 minutos postcarga de glucosa y perfil lipidico en la muestra de ayuno. Se determinó el IMC (peso/talla). Se definó obesidad (OB): como IMC > Pc95 para edad y sexo (CDC 2000), según el score z de IMC definimos: OB moderada: Score Z IMC > 2.0 y <2. y 2.5; OB grave: Score: Z IMC entre >_ a 2.5 y < 3.0; OB extrema: score Z IMC >_ 3.0. Resultados: 50% de la población presentó sindrome metabólico que se asoció significativamente a menor sensibilidad y mayor resistencia la insulina. y a mayor IMC. 65% presentó algún tipo de dislipidemia y el 64-% hiperinsulinemia. Obesidad sin ningún factor de riesgo estuvo presente en el 13%. La obesidad extrema que presento el 15% de los niños se asoció a obesidad parental.(AU)

Obesidad en pacientes prepúberes: detección temprana de sindrome metabólico / Obesity in pre pubertal patients: early detection of a metabolic syndrome

El síndrome metabólico (SM) constituye una constelación de anormalidades metabólicas asociadas con resistencia insulínica y obesidad habiéndose demostrado que los individuos con síndrome de resistencia insulínica están en riesgo de desarrollar diabetes tipo 2 y enfermedad cardiovascular. De allí la importancia de detectar en forma precoz los individuos en riesgo e función de prevención. Nuesto objetivo fue estimar la prevalencia de los componentes del SM en una población de niños obesos prepúberes . Se estudiaron 197 niños obesos prepúberes, sin patología asociada, asistidos en el Servicio de Nutrición del Hospital Garrahan. El sin-drome metabólico se definió según los críterios propuestos por Organización Mundial de la Salud (OMS) adaptados a la edad pediátrica. La evaluación comprendió antropometría, examen físico, determinación de TA y estudios bioquímicos. Se realizó prueba de sobrecarga a la glucosa. Se midió glucemias e insulina plasmática basales y a lo 30-60-90-120 minutos postcarga de glucosa y perfil lipidico en la muestra de ayuno. Se determinó el IMC (peso/talla). Se definó obesidad (OB): como IMC > Pc95 para edad y sexo (CDC 2000), según el score z de IMC definimos: OB moderada: Score Z IMC > 2.0 y <2. y 2.5; OB grave: Score: Z IMC entre >_ a 2.5 y < 3.0; OB extrema: score Z IMC >_ 3.0. Resultados: 50% de la población presentó sindrome metabólico que se asoció significativamente a menor sensibilidad y mayor resistencia la insulina. y a mayor IMC. 65% presentó algún tipo de dislipidemia y el 64-% hiperinsulinemia. Obesidad sin ningún factor de riesgo estuvo presente en el 13%. La obesidad extrema que presento el 15% de los niños se asoció a obesidad parental.

Invasive species and coal bed methane development in the Powder River Basin, Wyoming.

One of the fastest growing areas of natural gas production is coal bed methane (CBM) due to the large monetary returns and increased demand for energy from consumers. The Powder River Basin, Wyoming is one of the most rapidly expanding areas of CBM development with projections of the establishment of up to 50,000 wells. CBM disturbances may make the native ecosystem more susceptible to invasion by non-native species, but there are few studies that have been conducted on the environmental impacts of this type of resource extraction. To evaluate the potential effects of CBM development on native plant species distribution and patterns of non-native plant invasion, 36 modified Forest Inventory and Analysis plots (each comprised of four 168-m2 subplots) were established in the Powder River Basin, Wyoming. There were 73 168-m2 subplots on control sites; 42 subplots on secondary disturbances; 14 on major surface disturbances; eight on well pads; and seven on sites downslope of CBM wells water discharge points. Native plant species cover ranged from 39.5 +/- 2.7% (mean +/- 1 SE) in the secondary disturbance subplots to 17.7 +/- 7.5% in the pad subplots. Non-native plant species cover ranged from 31.0 +/- 8.4% in the discharge areas to 14.7 +/- 8.9% in the pad subplots. The control subplots had significantly less non-native species richness than the combined disturbance types. The combined disturbance subplots had significantly greater soil salinity than the control sites. These results suggest that CBM development and associated disturbances may facilitate the establishment of non-native plants. Future research and management decisions should consider the accumulative landscape-scale effects of CBM development on preserving native plant diversity.

Evaluación del estado nutricional en una población de niños internados en el Hospital Garrahan / Nutritional assessment of children hospitalized in Garrahan Pediatric Hospital

La malnutrición en la población hospitalizada se asocia con aumento de la mortalidad, complicaciones médicas, prolongación de la hospitalización y mayores costos. El objetivo del presente estudio fue conocer la prevalencia de malnutrición aguda y crónica en la población hospitalizada e identificar factores asociados. El estudio fue un corte transversal,, que incluyo a todos los pacientes internados en las salas de cuidados intermedios y moderados durante la semana del 12 al 19 de mayo del 2003. El diagnóstico nutricional se basó en métodos antropométricos, aplicando la clasificación de Waterloo modificada. La evaluación incluyó una encuesta administrada por el mismo médico que realizó la antropometría con datos de filiación y procedencia y con información sobre nivel de educación y actividad laboral de los padres, características de la vivienda , número de habitantes por cuarto, ingresos económicos, beneficios de planes sociales y cobertura social. Resultados: Fueron evaluados 198 pacientes con una edad media de 5,2 años más o menos 5, el 42,5% de los pacientes con compromiso nutricional: 19% malnutridos emaciados, 7,9% acortados y emaciados, 15,6% acortados y sobrepeso u obesidad el 11,7% de la población. De los niños con deficit de peso/talla (total 26,9%), el 12, 3% presentó un deficit leve, el 11,2% moderado y el 3,4% grave. 1 de acuerdo al nivel de ingreso las familias se clasificaron como indigentes (ingreso menor de $ 330 ): 43%; pobres (ingreso menor de $ 724) 37%; y con necesidades básicas satisfechas 20%. No se encontró asociación con variables sociales. Las variables biológicas que se asociaron con mayor frecuencia de malnutrición fueron la edad (p=0,04), la condición de cronocidad (p<0,01), y la duración de la internación mayor de 25 días (p=0.04%). En el subgrupo de pacientes evaluados co menos de 5 días de internados conpatologías agudas la frecuencia de malnutridos emaciados fue de 12,6%, de acortados 18,2, normales 60,6%, sobrepeso 9%.

Diffusion-weighted MR imaging of rim-enhancing brain masses: is markedly decreased water diffusion specific for brain abscess?

OBJECTIVE: This retrospective study investigated the specificity of restricted water diffusion for the diagnosis of brain abscess. Two of five rim-enhancing brain masses with restricted water diffusion (apparent diffusion coefficient of 0.79 [10(-3) mm(2)/sec] or less) were brain abscesses, but diagnoses in the other cases were metastatic squamous cell carcinoma (two cases) and radiation necrosis. CONCLUSION: Although an important diagnostic sign, restricted water diffusion is not specific for brain abscess.

[Spontaneous intracranial hypotension]. / Hipotensão intracraniana espontânea.

The authors consider some clinical and radiological aspects of spontaneous intracranial hypotension syndrome, based on the knowledge obtained from three clinical situations. Postural headache was a constant complaint. In all cases, magnetic resonance imaging data obtained was diffuse dural enhancement and, in two cases, bilateral subdural fluid collections. The increasing recognition of this syndrome led to its distinction from meningeal inflammatory or neoplasic conditions, sparing the patient from unnecessary investigation.

[Preoperative applications of cortical mapping with functional magnetic resonance]. / Aplicações pré-cirúrgicas do mapeamento cortical por Ressonância Magnética Funcional.

The authors describe a clinical experience in cortical brain mapping by Functional Magnetic Resonance Imaging (FMRI) with a 1.0 T MR scanner with BOLD technique and echo-planar imaging (EPI). A brief review is made of the theoretical basis of the BOLD technique and of the different functional tasks used. The main clinical applications of FMRI cortical mapping regarding the sensorimotor cortex of the hand and of language are mentioned. The experiment involves 29 patients, 16 with gliomas (G), 7 with mesial temporal sclerosis (MT S) and 6 with arteriovenous malformations (AVM) The most frequent clinical applications were the determination of the topographic relationship of the cerebral lesions with these eloquent cortices as well as the presurgical lateralization of language in medically intractable epileptic patients. The results are discussed in order to assess the FMRI cortical mapping role as a noninvasive method for presurgical planning, regarding the evaluation of the potential neurosurgical risks and the identification of viable cortex regions displaced or reorganized as a consequence of disease. Additionally, FMRI cortical mapping can also assess the atypical speech representations and the language lateralization of the patients.

[Three-dimensional magnetic resonance reconstruction. Significance of neurosurgical planning]. / Reconstruções tridimensionais cerebrais por Ressonância Magnética. Importância no planeamento neurocirúrgico.

The authors describe their experience with three-dimensional (3D) MRI reconstructions of the cerebral cortex in neurosurgical planning of cortical and subcortical lesions. The majority of the lesions were located on the cerebral hemispheres; there were also few cases of posterior fossa lesions. The authors selected three clinical cases to demonstrate the interest of 3D MRI. The authors describe another image processing method based on the three dimensional models obtained by using Curvilinear Multiplanar Reformatting (CMR) for the identification of subtle focal dysplastic lesions in patients with epilepsy. The advantages and disadvantages of those 3D MRI reconstructions methods are discussed and a comparison with conventional cross-sectional images is mentioned. The main disadvantages are the raw data relative to long acquisition time and the difficulty in sometimes establishing the cleavage plane between the cortex and extra-axial structures (e.g. young patients; lesions with great mass effect; lesions ventrally located in the cerebral lobes). In conclusion, the 3D MRI reconstructions of the cerebral cortex reveal additional information to conventional cross-sectional images and permit a precise location of the lesions. This is essential in some circumstances for neurosurgical planning and strategy, improving neurosurgical performance and patient outcome.

Transcatheter embolization for acute lower gastrointestinal hemorrhage.

PURPOSE: The authors review their experience using transcatheter embolization in the treatment of acute lower gastrointestinal hemorrhage. MATERIALS AND METHODS: A retrospective review was conducted on 17 patients who underwent superselective transcatheter embolization for an acute lower gastrointestinal hemorrhage. All 17 patients were followed clinically 4 days to 60 months (mean, 18.5 months) after embolization for the presence of ischemia or for recurrent bleeding. In addition, 12 of 17 patients were examined 1 day to 12 months (mean, 38.8 months) after embolization by means of colonoscopy or by pathologic review. RESULTS: Transcatheter embolization achieved immediate hemostasis in 15 of 17 patients (88%) and was the definitive treatment in 76%. The other two patients underwent successful surgical resections after incomplete hemostasis of cecal lesions. Two patients of the 15, with initially successful embolizations, had recurrent hemorrhage within 30 days; both underwent further embolization with one failure. No intestinal infarction or stricture developed in the 15 patients who underwent successful embolization. CONCLUSIONS: The authors' experience supports the role of transcatheter embolization as a primary means of therapy for patients with an acute lower gastrointestinal hemorrhage. Their data further supports growing evidence that superselective embolization may be most efficacious in reducing complication rates.

Spinal cord compression secondary to idiopathic retroperitoneal fibrosis.

Retroperitoneal fibrosis is a rare disorder in which the abnormal fibrotic tissue compresses retroperitoneal organs. In the majority of patients no obvious cause can be found, hence the name idiopathic retroperitoneal fibrosis. The process can also arise from other anatomic areas, suggesting a multifocal origin. We report a case of dorsal epidural compression in a 63-year-old patient harboring idiopathic retroperitoneal fibrosis. A magnetic resonance imaging scan revealed the precise location of the lesion. It is suggested that retroperitoneal fibrosis should be considered in the differential diagnosis of epidural spinal cord compression.

[A case of Wilson's disease studied using magnetic resonance: a new approach?]. / Um caso de doença de Wilson estudado por ressonância magnética: uma nova abordagem?

Wilson's disease is a genetically determined disorder of copper metabolism with increased deposition in brain and liver. With current imaging techniques--CT scan and conventional Nuclear Magnetic Resonance (NMR)--it has been possible to demonstrate oedema, neuronal loss and reactive gliosis, but not copper deposition. In the present study we report the observations, done in one patient, using a new high magnetic field (1.5 Tesla) NMR device. In these circumstances, we are able to expand the CT scan analysis by showing not only the oedema and the brain cell death but also the probable existence of copper deposits. Will this be true, it is first instance in which it has been possible to demonstrate, by a non invasive method, increased copper deposition in Wilson's disease. This possibility may be important to monitor the therapeutic efficacy of chelating agents and also to distinguish asymptomatic homozygous patients from heterozygous healthy carriers.