Disease-related complications in patients with metastatic hormone-sensitive prostate cancer.

INTRODUCTION: Prostate-specific antigen-based screening for prostate cancer reportedly does not improve cancer-specific survival. However, there remain concerns about the increasing incidence of advanced disease at initial presentation. Here, we investigated the incidences and types of complications that occur during the course of disease in patients with metastatic hormone-sensitive prostate cancer (mHSPC). METHODS: This study included 100 consecutive patients who were diagnosed with mHSPC at five hospitals from January 2016 to August 2017. Analyses were conducted using patient data extracted from a prospectively collected database, along with information about complications and readmission obtained from electronic medical records. RESULTS: The median patient age was 74 years and the median serum prostate-specific antigen level at diagnosis was 202.5 ng/mL. Ninety-nine patients received androgen deprivation therapy; 17 of these patients also received chemotherapy. During a mean follow-up period of 32.9 months, 41 patients reported bone pain; of these patients, 21 developed pathologic fractures and eight had cord compression. Twenty-eight patients developed retention of urine; of these patients, 10 (36%) required surgery and 11 (39%) required long-term urethral catheter use. Among 15 patients who developed ureteral obstruction, four (27%) required ureteral stenting and four (27%) required long-term nephrostomy drainage. Other complications included anaemia (41%) and deep vein thrombosis (4%). Fifty-nine (59%) patients had ≥1 unplanned hospital admission during the course of disease; 16% of such patients had >5 episodes of readmission. CONCLUSION: Among patients with mHSPC, 70% experienced disease-related complications and unplanned hospital admissions, which substantially burdened both patients and the healthcare system.

Spatial and temporal variations of coastal microplastic pollution in Hong Kong.

Further to our 2015-16 investigation, this study revealed the repeated presence of microplastics (MPs) in the coastal environment (Deep Bay, Tolo Harbour, Tsing Yi and Victoria Harbour) of Hong Kong from July 2016 to March 2017. The highest level of MPs in coastal surface water (17,182 particles/100 m3) was detected in Tsing Yi. Microplastic abundance in sediments of different sites (59 to 225 plastic particles/kg), however, did not vary significantly. MPs in the size of ≤1 mm were predominated in surface waters (53.3% to 98.6%) and sediments (79.1% to 96.8%). MPs in the shape of pellets and fragments were prevalent in surface waters and sediments respectively. Seasonal pattern of microplastic pollution was consistently observed in Victoria Harbour and Tsing Yi, where the number of MPs was always higher in dry season than in wet season for two consecutive years.

Microplastic pollution in the marine waters and sediments of Hong Kong.

The presence of plastic waste with a diameter of less than 5mm ("microplastics") in marine environments has prompted increasing concern in recent years, both locally and globally. We conducted seasonal surveys of microplastic pollution in the surface waters and sediments from Deep Bay, Tolo Harbor, Tsing Yi, and Victoria Harbor in Hong Kong between June 2015 and March 2016. The average concentrations of microplastics in local coastal waters and sediments respectively ranged from 51 to 27,909particles per 100m3 and 49 to 279particles per kilogram. Microplastics of different shapes (mainly fragments, lines, fibers, and pellets) were identified as polypropylene, low-density polyethylene, high-density polyethylene, a blend of polypropylene and ethylene propylene, and styrene acrylonitrile by means of Attenuated Total Reflectance - Fourier Transform Infrared Spectroscopy. This is the first comprehensive study to assess the spatial and temporal variations of microplastic pollution in Hong Kong coastal regions.

Computed tomography has low sensitivity for the diagnosis of early colon cancer.

AIM: The accuracy of computed tomography (CT) in detecting local invasion (T status) and nodal metastasis (N status) of colon cancer was determined. METHOD: Data on the preoperative CT scan of 153 lesions from 152 patients with colon cancer were reviewed retrospectively. Evaluation included the T stage and N stage of the TNM system. The results were compared with those obtained by histopathological examination of the resected tumour. RESULTS: Of the 153 tumours, 117 (76.5%) were correctly classified as Stage T1 and T2 (33 tumours) and Stage T3 and T4 (84 tumours) by CT. The sensitivity and specificity were 70.2% and 79.2%, respectively, and the positive and negative predictive values were 85.7% and 60.0%. When analysed according to the individual T stage (Tx/Tis, T1, 2, 3, 4) and N stage (N0, 1, 2), the kappa coefficient with linear weighting was 0.208 (fair agreement) for T stage and 0.154 (slight agreement) for N stage. The estimation of tumour size showed good agreement with histopathology (Spearman correlation coefficient 0.865). CONCLUSION: CT scanning of colonic cancer showed 75% accuracy in identifying T1 and T2 cancers combined, but gave poor agreement between CT and histopathology for individual T stages.

Epidermoid cyst of the testis.

Epidermoid cysts, though having a variable sonographic appearance, may present with an onion peel configuration, that is, concentric rings of alternating hyperechogenicities and hypoechogenicities. The absence of vascular flow on colour Doppler sonography is also consistent with the avascular nature of these lesions. By combining these two sonographic features and the absence of biochemical tumour marker, preoperative diagnosis of epidermoid cyst is possible and may prompt a testis sparing surgery rather than orchidectomy.

Renal capsular leiomyoma: Report of a case with unusual CT appearance.

Clinically symptomatic renal capsular leiomyomas are rare. Previous research has shown that these tumors are usually well-defined cystic lesions, solid lesions, or a mixture of the two. We report an unusual case of renal capsular leiomyoma which was well defined by ultrasonography, but lacked a well-defined edge in CT. The reason for the absence of a well-defined tumor edge is probably due to degeneration in certain parts of the tumor resulting in a different degree of enhancement. Thus, the possibility of renal capsular leiomyoma should be included in the differential diagnosis whenever a renal mass is found, especially when either CT or ultrasonography shows that the tumor has a smooth, well-defined contour.

Computed tomography features of spontaneously perforated pyometra: a case report.

Spontaneous perforation of pyometra is an extremely rare emergent gynecologic disease. We report a 73-year-old woman with a spontaneously perforated pyometra presenting with acute abdomen in the emergency department. A dedicated computed tomography examination of the abdominal and pelvic regions revealed the diagnosis. The patient recovered well after surgical intervention and antibiotic treatment.

Malignant mesothelioma of the tunica vaginalis testis.

Malignant mesothelioma of the tunica vaginalis is rare, and is usually not diagnosed until surgery is undertaken. Reports on the ultrasound features of this tumour are limited. We present an unusual case with ultrasound features mimicking an adenomatoid tumour.

CT of small bowel ischemia.

We evaluated the computed tomographic (CT) features of small bowel (SB) ischemia and necrosis and correlated the findings with clinical outcome or patient prognosis. Sixty-eight surgically or angiographically proved cases of SB ischemia were retrospectively reviewed. The CT features of intestinal ischemia were divided into three groups: (A) thinned bowel wall with poor enhancement, intramural gas, or portal venous gas; (B) thickened SB wall without superior mesenteric vein thrombosis; and (C) thickened SB wall with superior mesenteric vein thrombosis or intussusception. The evaluated factors included bowel wall or mucosal enhancement pattern, SB dilatation, mesenteric edema, and CT evidence of narrowing or occlusion of the superior mesenteric artery or vein. The bowel necrosis rates and mortalities were compared with chi-square test. Oral contrast material was not administered. Intramural gas and SB dilatation were associated with a higher bowel necrosis rate (eight of eight, 100%, and 17 of 21, 81%, respectively) in group A. Poor mucosal enhancement of the thickened bowel wall indicated a higher bowel necrosis rate in groups B (six of seven, 86%) and C (12 of 12, 100%) than did normal mucosal enhancement. Only intramural gas was accompanied with a higher mortality (six of eight, 75%). Intramural gas of a thinned bowel wall and poor mucosal enhancement of a thickened small bowel wall are useful signs of bowel necrosis. Intramural gas would indicate poor patient prognosis.

Ultrasound diagnosis of paratesticular rhabdomyosarcoma.

Rhabdomyosarcoma is the most common tumour of the lower genitourinary tract in children in the first two decades. Paratesticular rhabdomyosarcoma is associated with a significantly better outcome than lesions elsewhere in the genitourinary tract. Although ultrasound is considered the imaging modality of choice for evaluating intrascrotal pathology, the ultrasound appearance of paratesticular rhabdomyosarcoma has rarely been reported and may be confused with other disease entities such as epididymitis, adenomatoid tumour and leiomyoma. We present the ultrasound features of a paratesticular rhabdomyosarcoma, discussing the clinical features and differential diagnosis.

Case report: diabetic mastopathy.

Diabetic mastopathy is a source of confusion with breast carcinoma. The association between mastopathy and Type I diabetes of long duration has been reported, but this clinical condition is poorly recognized since breast examination is not routinely performed in young diabetic patients. Radiologists' awareness of the constellation of findings in diabetic mastopathy may spare patients from undergoing unwarranted surgical biopsies.

Differentiation of obstructive from non-obstructive small bowel dilatation on CT.

PURPOSE: to find a useful decision procedure for the differentiation of obstructive from non-obstructive small bowel (SB) dilatation on the computed tomography (CT). MATERIALS AND METHODS: four criteria were divided into different degrees and evaluated. These include: (A): continuity (non-continuous, continuous); (B): transition zone (absent, gradual, abrupt); (C): prestenotic SB fluid (minimal, about one-fourth, one-half, and three-fourths, nearly complete); and (D): colonic contents (minimal, moderate, considerable). One hundred fifty-three examinations, 86 obstructive and 67 non-obstructive, were analyzed using chi(2)-square tests to determine the relationship of each criterion to the presence of small bowel obstruction (SBO), whether the proportions of various degrees of these criteria differed significantly among the obstructive and non-obstructive subgroups, and to classify the criteria with a tree-based model (calculated by the computer) for the development of a useful decision procedure. RESULTS: in each of the four criteria, the trend of probability of obstruction was statistically significant (P=0.0000). The proportions of most, except two, of the various degrees of different criteria in the obstructive and non-obstructive subgroups differed significantly (P<0.01). The obstruction tends to have a continuou dilatation, an abrupt transition, more prestenotic SB fluids, and less colonic contents. The results of classification by a tree-based model were 76 true-positive, ten false-negative, six false-positive, and 61 true-negative. The sensitivity was 88%; specificity was 91%; positive predictive value was 93%; negative predictive value was 86%; and the overall accuracy was 90%. CONCLUSION: by analyzing the above four criteria together, a useful tree-based model can be developed and utilized as a supplemental decision procedure for the differentiation of obstructive from non-obstructive SB dilatation. The accuracy can be further promoted if the factor of a recognized pathologic condition is taken into consideration.

CT of large small-bowel diverticulum.

The previous reports concerning the computed tomographic (CT) appearances of small bowel diverticulum are usually limited to those of diverticulitis. We present the CT findings of uncomplicated, large small bowel diverticulum in five patients. An interesting coexistence of large small bowel diverticulum and small bowel volvulus will be mentioned. Four patients had recurrent abdominal pain in the past 2 years.

CT of agenesis and atrophy of the right hepatic lobe.

BACKGROUND: To identify and differentiate agenesis and severe atrophy of the right hepatic lobe on computed tomography (CT). METHODS: The CT examinations of three cases of agenesis and 11 cases of severe atrophy of the right hepatic lobe were reviewed. We evaluated visibility of the three hepatic veins, the two main portal veins (including their branches if necessary), the dilated intrahepatic ducts, enlargement of the medial and lateral segments of the left lobe and caudate lobe of the liver, presence of a retrohepatic gallbladder, hyperattenuation of the atrophic liver parenchyma, posterolateral interposition of the hepatic flexure of the colon, and upward migration of the right kidney. RESULTS: In the three cases of agenesis, no structure can be recognized as the right hepatic vein, right portal vein, or dilated right intrahepatic ducts. In the 11 cases of severe lobar atrophy, the right portal vein (or its branches) was recognized in eight cases, the right hepatic vein in four cases, and the dilated right intrahepatic ducts in 11 cases. The degree of enlargement of the lateral segment does not necessarily change inversely with the size of the medial segment and the caudate lobe. The retrohepatic gallbladder is present in eight cases (two in agenesis and six in atrophy). The phenomenon of hyperattenuation of the atrophic liver parenchyma was noted in six cases. CONCLUSION: Even though a retrohepatic gallbladder and a severely distorted hepatic morphology due to compensatory hypertrophy of the left and caudate lobes may raise a suspicion of agenesis of the right lobe of the liver, absence of visualization of all of the right hepatic vein, right portal vein and its branches, and dilated right intrahepatic ducts is a prerequisite of the diagnosis of agenesis of the right hepatic lobe on CT. In severe lobar atrophy, at least one of these structures is recognizable.

CT of the mesenteric vascular anatomy.

BACKGROUND: To evaluate the appearance of the arrangement of the superior mesenteric artery (SMA) and superior mesenteric vein (SMV) on computed tomography (CT) in normal patients and in patients with abdominal masses. METHODS: One hundred seventy-seven consecutive abdominal CT examinations of 143 adults and two children were reviewed. The relationship of the SMV to the SMA was recorded at four locations: the beginning of the mesenteric vessels and levels 3 cm, 6 cm, and 9 cm caudad to the beginning. The relationship of the SMV to the SMA was divided into four quadrants in relation to the SMA: I, ventral right or directly ventral; II, dorsal right or directly right; III, dorsal left or directly dorsal; and IV, ventral left or directly left. RESULTS: In the beginning of the SMV-SMA complex and levels 3 cm, 6 cm, and 9 cm caudal to the beginning, the SMV was located in quadrant I in 146, 84, 69, and 43 examinations, in quadrant II in 31, 93, 71, and 27 examinations, in quadrant III in zero, zero, five, and three examinations, and in quadrant IV in zero, zero, nine, and 15 examinations, respectively. The cases with SMV inversion had neither malrotation nor adjacent tumor compression. All the cases with an adjacent tumor-induced compression of the SMV-SMA complex had a normal SMV-SMA relationship. CONCLUSION: In the first 3 cm, the SMV is always to the right of the SMA. Caudal to the level of 6 cm, the SMV may be located to the left of the SMA without evidence of malrotation. A midgut nonrotation is more likely to be present when a proximal SMV inversion is coexistent with a rightward direction of the proximal jejunal vessels. A hypothetical depiction of the step-by-step change of the SMV-SMA relationship during embryologic development may explain the arrangement patterns of the mesenteric vessels in normal rotation and midgut nonrotation.

CT of the duodenojejunal junction.

To determine the location of the duodenojejunal junction (DJJ) at computed tomography (CT), we retrospectively reviewed 309 consecutive CT examinations. These included 162 men and 127 women (mean age = 57 years old, range = 11-85 years old). Some people received more than one examination. The clinical indications included various kinds of neoplasms, inflammations, congenital lesions, trauma, and other conditions. The DJJ was defined as the first sectioned ascending duodenum whose major part lies to the right side of the crossing part of the inferior mesenteric vein over the immediate beginning of the jejunum. Forty-nine examinations were excluded due to distortion of the DJJ by contiguous pathologic processes or nonadministration of intravenous contrast medium. In 36 examinations, the junctions were not identified. In the successfully identified 224 examinations, the DJJ was located to the left in 75 (33.5%), in the left half in 87 (38.8%), and in the right half or to the right of the vertebral body in 4 (1.8%) examinations. The midline of the DJJ was along the left margin and in the midline of the vertebral body in 53 (23.7%) and 5 (2.2%) examinations. In the anteroposterior direction, it was totally in front of the aorta in 189 (84.4%) and within the projected contour of the aorta in 11 (4.9%) examinations. The midline of the DJJ was along the anterior margin of the aorta in 24 (10.7%) examinations. Its cephalocaudal position was at the upper L1 in 36 (16.1%), lower L1 in 70 (31.3%), upper L2 in 75 (33.5%), and lower L2 in 21 (9.4%) examinations even though it ranged from upper T12 to upper L3.(ABSTRACT TRUNCATED AT 250 WORDS)