Comparison of unidimensional and bidimensional measurements in metastatic non-small cell lung cancer.

Tumour response evaluation after chemotherapy has become crucial in the development of many drugs. In contrast to the standard bidimensional WHO criteria, the recently described Response Evaluation Criteria In Solid Tumors are based on unidimensional measurements. The aim of the present study was to compare both methods in patients with metastatic non-small cell lung cancer. One hundred and sixty-four patients treated with two cisplatin-paclitaxel-based chemotherapy schedules between June 1994 and December 2000 were analysed. The measurements were reviewed by an independent panel of radiologists. Patient characteristics were: median age of 55 years (range 24-77 years) and a male to female ratio of 129 : 35. Adenocarcinoma and squamous carcinoma were the most common histologies. Vinorelbine was the third drug used in 77 patients and gemcitabine in 87. The ratio unidimensional/bidimensional was as follows: response 85 : 85; stable disease 32 : 32; progression 47 : 42 and not assessable 0 : 5. Kappa for agreement between responders was 0.951 (95% CI: 0.795-1.0) (P<0.001). Both WHO criteria and Response Evaluation Criteria In Solid Tumors give similar results in assessing tumour response in patients with non-small cell lung cancer after chemotherapy. The unidimensional measurement could replace the more complex bidimensional one.

[Synchronous osteochondroid hamartoma and squamous cell carcinoma of the larynx]. / Hamartoma osteocondroide y carcinoma epidermoide de laringe sincrónicos.

BACKGROUND: Soft-tissue tumors of the larynx are rare, especially hamartomas. Fewer than a dozen well-documented cases have been described. We report the case of a 65 year-old man diagnosed of a synchronous epithelial tumor of the right vocal fold and a soft-tissue tumor of the contralateral lamina of the thyroid cartilage. METHODS: CT scan revealed a low-attenuating, expansive mass involving the left ala of the thyroid cartilage without airway compromise airway. The lesion contained small, scattered calcifications and the mucosa was intact, suggesting a cartilaginous tumor. The patient underwent endoscopic resection of the right vocal fold tumor and subtotal resection of the left ala of the thyroid via median thyrotomy. RESULTS: Pathology revealed a squamous-cell carcinoma of the vocal fold and an osteochondroid hamartoma within the thyroid cartilage. The management of patients with laryngeal lesions suggestive of a cartilaginous nature is discussed. CONCLUSIONS: To our knowledge, this is the first case of a synchronous laryngeal hamartoma and carcinoma reported in the literature.

Retroperitoneal fibrosis: typical and atypical manifestations.

Retroperitoneal fibrosis (RPF) is a well described clinical entity that is being diagnosed with increasing frequency. RPF is characterized by replacement of the normal tissue of the retroperitoneum with fibrosis and/or chronic inflammation. However, aetiology, clinical presentation and radiological appearance in many cases are protean. Up to 15% of patients have additional fibrotic processes outside the retroperitoneum. In the abdomen, RPF may spread contiguously to involve multiple structures in both the retroperitoneum and the peritoneal cavity or multiple non-contiguous sites may be involved. We retrospectively reviewed 30 patients (19 male, 11 female; age range 28-79 years) with biopsy proven RPF. Although we found RPF most commonly as an isolated fibrotic plaque in the lower lumbar region (18 patients), 12 patients (40%) presented with RPF in atypical locations (4 peripancreatic, 1 periduodenal, 7 pelvic). The RPF was non-malignant in 24 patients (21 idiopathic, 2 perianeurysmal, 1 ergot-derivative treatment) and malignant in six cases. We present a pictorial review of the varied appearances of RPF, concentrating on atypical sites. The radiological differential diagnosis and its appearance with various imaging modalities are discussed. Current concepts with respect to management, prognosis and treatment are summarized.

Low density barium and bentonite mixture versus high density barium: a comparative study to optimize negative gastrointestinal contrast agents for MRI.

The purpose of this study was to compare the patient tolerance and efficacy, as magnetic resonance imaging negative oral contrast agents, of a mixture of clay compound bentonite and low density barium sulfate suspension with that of higher density barium sulfate. Twenty patients were randomized into two groups: 10 patients receiving a mixture of low concentration 60% w/v barium sulfate plus 2.5% w/v bentonite, and 10 patients receiving 220% w/v barium sulfate Liuqid-HD (E-Z-EM, Westbury, NY). Post-contrast Spin-echo (SE) T1- and T2-weighted images (WI) were obtained on a 1.0T magnet. Two independent readers scored the overall intraluminal signal intensity and delineation of the gastrointestinal tract and adjacent organs. Patient acceptance was evaluated via a short questionnaire, by recording spontaneous comments and documenting the quantity of contrast agent ingested. There was greater intraluminal bowel signal reduction and organ delineation with 220% w/v barium than with the barium-bentonite mixture on both SE T1WI (p = 0.03) and SE T2WI (p = 0.42). With both agents there was greater signal reduction on SE T2WI than SE T1WI. Higher scores for organ delineation for both contrast agents were seen with SE T1WI. With 220% w/v barium, there was significantly better delineation of the pancreatic body (p = 0.02) and pancreatic tail (p = 0.02) on T1WI compared with SE T2WI. With the barium-bentonite mixture, SE T1WI showed improved delineation of jejunum compared with SE T2WI (p = 0.03). There were no statistically significant differences between the volume of contrast ingested in the two groups. Abdominal cramps were recorded for one patient in each group. These results suggest that barium-bentonite mixture, although useful as a negative gastro-intestinal contrast agent, is not as effective as 220% w/v barium. Further studies with a larger patient population and concentration optimization studies are needed.

Comparison of solid and liquid culture media with polymerase chain reaction for detection of Mycobacterium tuberculosis in clinical samples.

The aim of this study was to determine the sensitivity of different methods--two commercial polymerase chain reaction (PCR) kits (a protocol of nested PCR and a protocol of amplification of the IS6110 insertion element), the radiometric Bactec system, the Septi-Chek AFB culture system, and culture in Löwenstein-Jensen (LJ) solid medium--for the detection of Mycobacterium tuberculosis. One hundred clinical samples from 51 patients with culture-positive tuberculosis (81 specimens) and 19 controls (19 specimens) were used. Eighty-nine percent of the samples were smear negative. In the 81 specimens obtained from patients with tuberculosis, the frequency of positivity was 66.6% for nested PCR, 63% for culture in liquid media, 38.3% for IS6110 assay, and 28.4% for culture in LJ medium. In 18 samples obtained by invasive procedures in patients with tuberculosis, mycobacterial DNA was detected by nested PCR in 83.3% (including all samples positive by culture on liquid media), by culture in liquid media in 77.7% by culture on LJ medium in 27.7%, and by the IS6110 assay in 11.1%. No false-positive results were obtained from the negative control specimens with any of the techniques tested. The sensitivity of the reamplification protocol appears to be superior to that of the IS6110 assay and similar to that of the Bactec system.

Ring enhancement in ultrasmall superparamagnetic iron oxide MR imaging: a potential new sign for characterization of liver lesions.

OBJECTIVE: We performed this study to evaluate the incidence and significance of ring enhancement after i.v. administration of an ultrasmall superparamagnetic iron oxide (USPIO) particle (Code 7227), a reticuloendothelial contrast agent with potential use as a blood-pool agent, for characterizing focal hepatic lesions. SUBJECTS AND METHODS: Conventional T1-weighed imaging, fat-suppressed T1-weighted imaging, conventional T2-weighted imaging, and fast T2-weighted imaging of the liver were obtained in 27 patients with 43 liver lesions before and after i.v. administration of a USPIO preparation. All lesions were larger than 1 cm; 29 were malignant and 14 were benign. Diagnosis was confirmed in all cases, either pathologically (19 patients) or by follow-up examination (eight patients). Two readers independently evaluated each pulse sequence for the presence of ring enhancement of hepatic lesions. RESULTS: Ring enhancement was noted only on T1-weighted images, with no ring enhancement evident on T2-weighted images. Twenty of 43 (47%) lesions showed ring enhancement, including 18 of 29 (62%) malignant lesions and two of 14 (14%) benign lesions (p < .011); Wilcoxon signed rank test). Fat-suppressed T1-weighted imaging showed ring enhancement better than or equal to conventional T1-weighted imaging in all cases, with ring enhancement of 15 of 18 (83%) malignant lesions and two of two benign lesions better demonstrated on fat-suppressed T1-weighted imaging sequences (p < or = .025). CONCLUSION: Ring enhancement after i.v. administration of Code 7227 is a frequent finding seen more often with malignant than benign lesions, potentially identifying a new MR imaging feature for the characterization of liver lesions. The identification of ring enhancement on T1-weighted images attests to the significant blood-pool effects of USPIO particles.