Tension hydrocele as an additional cause of acute scrotum: case series and literature review.

PURPOSE: To describe the correlation between acute scrotum pain and tension hydrocele, focusing on US and Doppler features. METHODS AND MATERIALS: We evaluated retrospectively a series of five patients with a long history of hydrocele who were referred to our institutions for increasing acute scrotal pain. Patients were approached with gray scale US of both testes, as well as with color-Doppler and spectral analysis, comparing the results with those after aspiration and symptoms relief. RESULTS: All patients had a "simple" hydrocele with no internal septa; the involved testicles had a "flattened" appearance and parenchymal Doppler signals showed increased intratesticular vascular resistance. One patient had a low diastolic flow, compared to the contralateral testis, with an increased RI value, one had no diastolic flow, two patients had retrograde diastolic flow, and the remaining one had no intratesticular flow visible. After decompression, there were disappearance of pain and improved flow with normalization of testicular vascularity; post-ischemic hyperemia was appreciated in the two patients examined immediately after fluid aspiration, while normal flow was seen in three studies carried out the day after. CONCLUSION: To conclude, tension hydrocele is a rare condition that produces alterations of form and circulation of testicles, increase of intraparenchymal vascular resistances and strong and continuous pain, mimicking a testicular torsion. The increase in pressure produces an effect similar to that observed in a compartment syndrome. US findings, together with clinical assessment, indicate when emergency decompression may be appropriate to relieve testicular ischemia.

A radiofrequency system for in vivo hyperpolarized 13 C MRS experiments in mice with a 3T MRI clinical scanner.

Hyperpolarized carbon-13 magnetic resonance spectroscopy (MRS) is a powerful tool to explore tissue metabolic state, by permitting the study of intermediary metabolism of biomolecules in vivo. However, a number of technological problems still limit this technology and need innovative solutions. In particular, the low molar concentration of derivate metabolites give rise to low signal-to-noise ratio (SNR), which makes the design and development of dedicated radiofrequency (RF) coils a fundamental task. In this article, the authors describe the simulation and the design of a RF coils configuration for MR experiments in mice, constituted by a 1 H whole body volume RF coil for imaging and a 13 C single circular loop surface RF coil for performing 13 C acquisitions. After the building, the RF system was employed in an in vivo experiment in a mouse injected with hyperpolarized [1-13 C]pyruvate by using a 3 T clinical MR scanner. SCANNING 38:710-719, 2016. © 2016 Wiley Periodicals, Inc.

Post-exercise contractility, diastolic function, and pressure: operator-independent sensor-based intelligent monitoring for heart failure telemedicine.

BACKGROUND: New sensors for intelligent remote monitoring of the heart should be developed. Recently, a cutaneous force-frequency relation recording system has been validated based on heart sound amplitude and timing variations at increasing heart rates. AIM: To assess sensor-based post-exercise contractility, diastolic function and pressure in normal and diseased hearts as a model of a wireless telemedicine system. METHODS: We enrolled 150 patients and 22 controls referred for exercise-stress echocardiography, age 55 +/- 18 years. The sensor was attached in the precordial region by an ECG electrode. Stress and recovery contractility were derived by first heart sound amplitude vibration changes; diastolic times were acquired continuously. Systemic pressure changes were quantitatively documented by second heart sound recording. RESULTS: Interpretable sensor recordings were obtained in all patients (feasibility = 100%). Post-exercise contractility overshoot (defined as increase > 10% of recovery contractility vs exercise value) was more frequent in patients than controls (27% vs 8%, p < 0.05). At 100 bpm stress heart rate, systolic/diastolic time ratio (normal, < 1) was > 1 in 20 patients and in none of the controls (p < 0.01); at recovery systolic/diastolic ratio was > 1 in only 3 patients (p < 0.01 vs stress). Post-exercise reduced arterial pressure was sensed. CONCLUSION: Post-exercise contractility, diastolic time and pressure changes can be continuously measured by a cutaneous sensor. Heart disease affects not only exercise systolic performance, but also post-exercise recovery, diastolic time intervals and blood pressure changes--in our study, all of these were monitored by a non-invasive wearable sensor.

The session of the two dreams.

Through the discussion of the clinical material the author tries to show how numerous aspects of traditional Jungian analysis are close to several theoretical and clinical developments of Relational Psychoanalysis. A short introduction about relational psychoanalysis is given. The relational aspects of Jungian theory and praxis are underlined. If we refer to these theoretical constructs, it becomes possible to work in an original way and think of the clinical setting as different from the classical Freudian one, without abandoning Jungian tradition.

Arterial pressure changes monitoring with a new precordial noninvasive sensor.

BACKGROUND: Recently, a cutaneous force-frequency relation recording system based on first heart sound amplitude vibrations has been validated. A further application is the assessment of Second Heart Sound (S2) amplitude variations at increasing heart rates. The aim of this study was to assess the relationship between second heart sound amplitude variations at increasing heart rates and hemodynamic changes. METHODS: The transcutaneous force sensor was positioned in the precordial region in 146 consecutive patients referred for exercise (n = 99), dipyridamole (n = 41), or pacing stress (n = 6). The curve of S2 peak amplitude variation as a function of heart rate was computed as the increment with respect to the resting value. RESULTS: A consistent S2 signal was obtained in all patients. Baseline S2 was 7.2 +/- 3.3 mg, increasing to 12.7 +/- 7.7 mg at peak stress. S2 percentage increase was + 133 +/- 104% in the 99 exercise, + 2 +/- 22% in the 41 dipyridamole, and + 31 +/- 27% in the 6 pacing patients (p < 0.05). Significant determinants of S2 amplitude were blood pressure, heart rate, and cardiac index with best correlation (R = .57) for mean pressure. CONCLUSION: S2 recording quantitatively documents systemic pressure changes.

Diastolic time - frequency relation in the stress echo lab: filling timing and flow at different heart rates.

UNLABELLED: A cutaneous force-frequency relation recording system based on first heart sound amplitude vibrations has been recently validated. Second heart sound can be simultaneously recorded in order to quantify both systole and diastole duration. AIMS: 1- To assess the feasibility and extra-value of operator-independent, force sensor-based, diastolic time recording during stress. METHODS: We enrolled 161 patients referred for stress echocardiography (exercise 115, dipyridamole 40, pacing 6 patients).The sensor was fastened in the precordial region by a standard ECG electrode. The acceleration signal was converted into digital and recorded together with ECG signal. Both systolic and diastolic times were acquired continuously during stress and were displayed by plotting times vs. heart rate. Diastolic filling rate was calculated as echo-measured mitral filling volume/sensor-monitored diastolic time. RESULTS: Diastolic time decreased during stress more markedly than systolic time. At peak stress 62 of the 161 pts showed reversal of the systolic/diastolic ratio with the duration of systole longer than diastole. In the exercise group, at 100 bpm HR, systolic/diastolic time ratio was lower in the 17 controls (0.74 +/- 0.12) than in patients (0.86 +/- 0.10, p < 0.05 vs. controls). Diastolic filling rate increased from 101 +/- 36 (rest) to 219 +/- 92 ml/m2* s-1 at peak stress (p < 0.5 vs. rest). CONCLUSION: Cardiological systolic and diastolic duration can be monitored during stress by using an acceleration force sensor. Simultaneous calculation of stroke volume allows monitoring diastolic filling rate.Stress-induced "systolic-diastolic mismatch" can be easily quantified and is associated to several cardiac diseases, possibly expanding the spectrum of information obtainable during stress.

Cardiac reflections and natural vibrations: force-frequency relation recording system in the stress echo lab.

BACKGROUND: The inherent ability of ventricular myocardium to increase its force of contraction in response to an increase in contraction frequency is known as the cardiac force-frequency relation (FFR). This relation can be easily obtained in the stress echo lab, where the force is computed as the systolic pressure/end-systolic volume index ratio, and measured for increasing heart rates during stress. Ideally, the noninvasive, imaging independent, objective assessment of FFR would greatly enhance its practical appeal. OBJECTIVES: 1 - To evaluate the feasibility of the cardiac force measurement by a precordial cutaneous sensor. 2 - To build the curve of force variation as a function of the heart rate. 3 - To compare the standard stress echo results vs. this sensor operator-independent built FFR. METHODS: The transcutaneous force sensor was positioned in the precordial region in 88 consecutive patients referred for exercise, dipyridamole, or pacing stress. The force was measured as the myocardial vibrations amplitude in the isovolumic contraction period. FFR was computed as the curve of force variation as a function of heart rate. Standard echocardiographic FFR measurements were performed. RESULTS: A consistent FFR was obtained in all patients. Both the sensor built and the echo built FFR identifiy pts with normal or abnormal contractile reserve. The best cut-off value of the sensor built FFR was 15.5 g * 10-3 (Sensitivity = 0.85, Specificity = 0.77). Sensor built FFR slope and shape mirror pressure/volume relation during stress. This approach is extendable to daily physiological exercise and could be potentially attractive in home monitoring systems.

How the mind understands other minds: cognitive psychology, attachment and reflective function.

Jung's epistemological relativistic attitude was very advanced for his time and very much in line with the contemporary philosophy of science. Further, Jung states that the patient's unconscious has the capacity to represent itself by creating metaphors which give the therapist all the help he might need in treating his patient. As such, Jungian analysts have not been encouraged to embark on theoretical work and as a result, the Jungian movement has been lacking those theories that connect general psychological principles with clinical practices. In an attempt to enlarge our 'middle-range theories', we shall discuss Peter Fonagy's concept of reflective function. In our opinion, the theoretical hypothesis regarding the instinct of reading the mind (Baron-Cohen 1995) and Fonagy's idea of reflective function are extremely useful in our Jungian clinical practice and these concepts are utilizable because they are not at odds with analytical psychology's general epistemological and theoretical framework.

Epistemological premise, developmental idea, main motivation in Jung's and Kohut's psychoanalysis: looking for some analogies.

We are living the passage from the positivistic ideal to a new cultural climate which may be called post-modernism, subjectivism or perspectivism and in which we have lost the conviction that it is possible to reach an absolute knowledge. This climate can become a strong stimulus to a dialogue and a comparison among different psychoanalytical schools and between psychoanalysis and empirical research to find some of the reference points we need in our work. In my paper I will compare self psychology and analytic psychology in order to point out several strong analogies. Firstly, they are based on the same methodological option which gathers knowledge through an empathic understanding 'from within'. According to both Jung and Kohut the individual has within himself a psycho-biological potential, an individual pre-formed core that asks to evolve completely: the central motivation of human beings is the realization of their own individuality. This shared theoretical and epistemological ground conveys convergences in the clinical field between the two disciplines (interpretation of dreams, respect of resistance, diminishing attitude regarding sexual drives, etc.) and specifically determines an attitude of the analyst, which respects the individual process of development, which pays attention to the inner experience, and which gives importance to the analyst's and the patient's subjective experience.

Psychoanalysis and empirical research.

At the beginning of the nineteenth century, the idea of reason began to lose its universal and absolute value, undermining the view of science as a form of objective knowledge that reveals a fundamental reality. These changes have also had an impact on psychoanalysis, leading to a proliferation of theories and the end of a positivistic approach, epitomized by a 'neutral' analyst who knows the contents of the patient's mind. Hermeneutic philosophy provides a tool with which to explore both theoretical multiplicity and the contribution of the analyst's subjectivity to the analytic process. Furthermore, a hermeneutic approach does not have to be hostile to empirical science, but can be integrated with it in a 'scientific-hermeneutic model' in which historical and biological principles are given equal value.